Healthcare Provider Details

I. General information

NPI: 1770206831
Provider Name (Legal Business Name): SHAWANDA BURKS BA, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD STE 312
SHREVEPORT LA
71104-3358
US

IV. Provider business mailing address

2620 CENTENARY BLVD STE 312
SHREVEPORT LA
71104-3358
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-9935
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: