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General NPI Number Information
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NPI Number | 1225849524
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Entity Type | Individual
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Provider Name | ELIZABETH GRACE MCKELLAR
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST STE 369
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City | SHREVEPORT
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State | LA
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Zip | 71105-2413
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Country | US
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Telephone | 318-210-0587
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Fax |
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Provider Business Mailing Address
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Address Line | 171 PENNSYLVANIA AVE
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City | SHREVEPORT
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State | LA
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Zip | 71105-3317
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Country | US
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Telephone | 318-990-2001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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