Individual
CHERI D LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1453 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-6800
(318) 681-4138
(318) 681-5157
Mailing address
2900 SAINT MICHAEL DR STE 401, TEXARKANA, TX 75503-5211
(903) 614-5372
(903) 614-5343
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA200093
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
LA
Enumeration date
10/05/2006
Last updated
03/08/2021
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