Individual
KATIE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3108 WAGNER ST, SHREVEPORT, LA 71108-3750
(318) 572-1630
Mailing address
3108 WAGNER ST, SHREVEPORT, LA 71108-3750
(318) 572-1630
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
LA
Other
Enumeration date
03/23/2022
Last updated
03/26/2022
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