Individual
NICOLETTE HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2518 BERT KOUNS IND. LOOP, SHREVEPORT, LA 71118-3112
(318) 212-5437
(318) 212-5825
Mailing address
2518 BERT KOUNS IND. LOOP, SHREVEPORT, LA 71118-3112
(318) 212-5437
(318) 212-5825
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
204992
LA
Other
Enumeration date
04/15/2009
Last updated
08/31/2012
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