Healthcare Provider Details

I. General information

NPI: 1023478724
Provider Name (Legal Business Name): MYESHA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 GREENACRES BLVD
BOSSIER CITY LA
71111-6052
US

IV. Provider business mailing address

9403 MANSFIELD RD
SHREVEPORT LA
71118-3815
US

V. Phone/Fax

Practice location:
  • Phone: 318-458-8004
  • Fax:
Mailing address:
  • Phone: 318-861-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12848
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: