Healthcare Provider Details

I. General information

NPI: 1528530045
Provider Name (Legal Business Name): SHELIA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1100
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

925 ELLIS DR
WASKOM TX
75692-3625
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-4086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: