Individual
CORETTA SMITH KIMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
4218 SCENIC DR, SHREVEPORT, LA 71119-7141
(318) 572-7104
Mailing address
4218 SCENIC DR, SHREVEPORT, LA 71119-7141
(318) 572-7104
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/11/2017
Last updated
04/16/2019
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