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Individual

CHARETTA L CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7125 SUNTAN ST, SHREVEPORT, LA 71108-4927
(318) 465-6614
Mailing address
7125 SUNTAN ST, SHREVEPORT, LA 71108-4927
(318) 205-1252

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
007325154
LA

Other

Enumeration date
03/11/2022
Last updated
03/11/2022
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