Individual
SHANNON KOVELESKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1860 FAIRFIELD AVE, SHREVEPORT, LA 71101-4431
(318) 675-1313
(318) 675-1319
Mailing address
1860 FAIRFIELD AVE, SHREVEPORT, LA 71101-4431
(318) 675-1313
(318) 675-1319
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200784
LA
Other
Enumeration date
05/27/2015
Last updated
05/27/2015
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