Healthcare Provider Details

I. General information

NPI: 1174260194
Provider Name (Legal Business Name): DEEKSHITHA MANNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-7407
US

IV. Provider business mailing address

309 JACKSON ST # 7004
MONROE LA
71201-7407
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-7172
  • Fax: 318-966-8788
Mailing address:
  • Phone: 318-966-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number336865
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: