Individual
KELLY PATRICIA LEUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1042 CRESSMONT ST, BOSSIER CITY, LA 71111-5759
(831) 246-2088
Mailing address
1042 CRESSMONT ST, BOSSIER CITY, LA 71111-5759
(831) 246-2088
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
Other
Enumeration date
06/17/2018
Last updated
06/17/2018
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