Individual
KESHANA DOMINIQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9278 REUNION DR, SHREVEPORT, LA 71118-2245
(318) 761-0433
Mailing address
9278 REUNION DR, SHREVEPORT, LA 71118-2245
(318) 761-0433
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
01/02/2022
Last updated
01/02/2022
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