Individual
AMANDA LYNN CALLEGAN-POCHE'
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1023 PROVENANCE PL STE 130, SHREVEPORT, LA 71106-7796
(318) 626-0000
Mailing address
6165 VICTORIA LN, KEITHVILLE, LA 71047-9144
(225) 776-6752
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
312618
LA
208000000X
Pediatrics Physician
312618
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2388312
—
LA
Enumeration date
04/15/2015
Last updated
09/27/2023
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