Healthcare Provider Details

I. General information

NPI: 1093173551
Provider Name (Legal Business Name): SHENEATRA CUTRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S HIGHLAND DR
MANY LA
71449-3719
US

IV. Provider business mailing address

2525 YOUREE DR STE 110
SHREVEPORT LA
71104-3600
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5200
  • Fax: 318-256-5201
Mailing address:
  • Phone: 318-742-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: