Individual
KEONA MONIQUE ISAAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 KIMBROUGH BLVD, TALLULAH, LA 71282-4307
(318) 341-6785
Mailing address
120 KIMBROUGH BLVD, TALLULAH, LA 71282-4307
(318) 341-6785
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
1334671108
LA
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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