Individual
KANITRA ELMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
202 LAKE ST, LAKE PROVIDENCE, LA 71254-2628
(318) 552-5126
(318) 552-5127
Mailing address
2984 HIGHWAY 80 W LOT 58, CALHOUN, LA 71225-7915
(318) 552-5126
(318) 552-5127
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
111966
LA
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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