Individual
AMANDA KAYLEIGH TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6938
(318) 629-2870
Mailing address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6938
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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