Individual
MISS GRACYN LEE GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2709 MACKEY LN, SHREVEPORT, LA 71118-2556
(318) 671-1131
Mailing address
2709 MACKEY LN, SHREVEPORT, LA 71118-2556
(318) 671-1131
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
329002
LA
Other
Enumeration date
11/11/2021
Last updated
08/24/2024
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