Individual
SHANNON L MCTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 LINE AVE, SUITE 204, SHREVEPORT, LA 71101-4639
(318) 629-5001
(318) 629-5020
Mailing address
1500 LINE AVE, SUITE 202, SHREVEPORT, LA 71101-4639
(318) 629-5505
(318) 629-5506
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP05879
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP05879
LA
Other
Enumeration date
06/23/2009
Last updated
07/18/2025
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