Healthcare Provider Details

I. General information

NPI: 1851829063
Provider Name (Legal Business Name): MRS. TESSIE SHARINE CELESTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 KIRKMAN ST STE C
LAKE CHARLES LA
70601-5391
US

IV. Provider business mailing address

1202 KIRKMAN ST STE C
LAKE CHARLES LA
70601-5391
US

V. Phone/Fax

Practice location:
  • Phone: 337-990-5305
  • Fax: 855-239-9737
Mailing address:
  • Phone: 337-990-5305
  • Fax: 337-990-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: