Healthcare Provider Details

I. General information

NPI: 1801752712
Provider Name (Legal Business Name): VICTORIA MARKIYA KILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TOWER DR
MONROE LA
71201-5045
US

IV. Provider business mailing address

111 UNIVERSITY ST
TALLULAH LA
71282-2506
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1300
  • Fax:
Mailing address:
  • Phone: 318-341-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number012685155
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: