Individual
MISS JATIQUALYN DEJENAE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118
(318) 603-4696
Mailing address
2933 LOONEY ST, SHREVEPORT, LA 71103-2107
(318) 946-1085
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/30/2017
Last updated
05/22/2018
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