Individual
MIRANDA RASHAY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP STUDENT
Contact information
Practice address
2704 SHED RD APT 163I, BOSSIER CITY, LA 71111-3368
(318) 344-3864
Mailing address
2704 SHED RD APT 163I, BOSSIER CITY, LA 71111-3368
(318) 344-3864
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RN140491
LA
Other
Enumeration date
11/29/2025
Last updated
11/29/2025
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