Individual
SHAMEKA SHANTL SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3267 SNOWY EGRET DR, LAKE CHARLES, LA 70615-5364
(337) 853-0474
Mailing address
3267 SNOWY EGRET DR, LAKE CHARLES, LA 70615-5364
(337) 853-0474
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
006584019
LA
Other
Enumeration date
09/19/2021
Last updated
09/19/2021
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