Healthcare Provider Details

I. General information

NPI: 1235898677
Provider Name (Legal Business Name): JENNIFER CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 GORTON RD
SHREVEPORT LA
71119-5221
US

IV. Provider business mailing address

3445 GORTON RD
SHREVEPORT LA
71119-5221
US

V. Phone/Fax

Practice location:
  • Phone: 318-453-0855
  • Fax:
Mailing address:
  • Phone: 318-453-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberCRT20013
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: