Individual
BEAUNKA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11616 SOUTHFORK AVE STE 203, BATON ROUGE, LA 70816-5241
(225) 291-9646
(225) 291-9692
Mailing address
11616 SOUTHFORK AVE STE 203, BATON ROUGE, LA 70816-5241
(225) 291-9646
(225) 291-9692
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600751961
—
LA
Enumeration date
06/09/2016
Last updated
05/20/2019
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