Individual
KELLIE MANDYGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3341 YOUREE DR, SHREVEPORT, LA 71105-2149
(318) 219-4167
(318) 219-4834
Mailing address
3341 YOUREE DR, SHREVEPORT, LA 71105-2149
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
11/08/2016
Last updated
07/24/2019
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