Individual
NIKELL THOMPSON FORTIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
561 MORNINGSIDE DR, GRETNA, LA 70056
(504) 210-6606
Mailing address
561 MORNINGSIDE DR, GRETNA, LA 70056-2830
(504) 210-6606
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-1447618
—
LA
Enumeration date
08/29/2018
Last updated
08/30/2018
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