Individual
JAKITHA ANTIONETTE BURRELL-LOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9543 LEASIDE WAY, SHREVEPORT, LA 71118-4310
(318) 461-1414
Mailing address
9543 LEASIDE WAY, SHREVEPORT, LA 71118-4310
(318) 461-1414
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
008633137
LA
Other
Enumeration date
11/29/2021
Last updated
11/29/2021
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