Individual
ANDREA ROSE JUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1549 E 70TH ST STE 300, SHREVEPORT, LA 71105-5056
(318) 300-3898
(318) 797-4241
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
333904
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15835900
CAQH
—
Enumeration date
07/22/2021
Last updated
10/04/2024
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