Individual
DETRIC BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3225 TAMMYE LN, BOSSIER CITY, LA 71111-2823
(318) 678-3748
Mailing address
3225 TAMMYE LN, BOSSIER CITY, LA 71111-2823
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/05/2018
Last updated
04/12/2019
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