Healthcare Provider Details

I. General information

NPI: 1073181541
Provider Name (Legal Business Name): SHAEMMA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 MANSFIELD RD
SHREVEPORT LA
71118-3815
US

IV. Provider business mailing address

713 MCDONALD AVE # L57
RUSTON LA
71270-4666
US

V. Phone/Fax

Practice location:
  • Phone: 318-861-8938
  • Fax:
Mailing address:
  • Phone: 318-265-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: