Individual
JERRY LLOYD WILLIFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
850 OLIVE ST STE A, SHREVEPORT, LA 71104-2162
(318) 239-4860
(805) 295-4715
Mailing address
PO BOX 4506, SHREVEPORT, LA 71134-0506
(318) 239-4860
(805) 295-4715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
211128
LA
Other
Enumeration date
01/01/2021
Last updated
01/01/2021
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