Healthcare Provider Details

I. General information

NPI: 1962148304
Provider Name (Legal Business Name): NEQUONDRA KEOKA CALEB SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11616 SOUTHFORK AVE STE 403
BATON ROUGE LA
70816-5241
US

IV. Provider business mailing address

31522 CALEB LN
SPRINGFIELD LA
70462-8134
US

V. Phone/Fax

Practice location:
  • Phone: 225-261-7143
  • Fax:
Mailing address:
  • Phone: 985-981-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17377
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: