Healthcare Provider Details

I. General information

NPI: 1073976577
Provider Name (Legal Business Name): CARGINA JOHNETTE MYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 LINWOOD AVE
SHREVEPORT LA
71108
US

IV. Provider business mailing address

1048 DEVEREAUX RD
SHREVEPORT LA
71107-3004
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-3093
  • Fax:
Mailing address:
  • Phone: 318-423-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17040
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: