Individual
KEWON HIKEEM FERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 N THOMAS DR, SHREVEPORT, LA 71107-6503
(318) 424-8345
Mailing address
200 N THOMAS DR, SHREVEPORT, LA 71107-6503
(318) 424-8345
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
522089886
—
LA
Enumeration date
03/29/2017
Last updated
03/29/2017
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