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General NPI Number Information
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NPI Number | 1255291506
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Entity Type | Organization
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Legal Business Name | 1ST CHOICE MEDICAL LAB LLC
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 2920 KNIGHT ST STE 131
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City | SHREVEPORT
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State | LA
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Zip | 71105-2412
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Country | US
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Telephone | 877-868-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 2920 KNIGHT ST STE 131
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City | SHREVEPORT
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State | LA
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Zip | 71105-2412
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Country | US
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Telephone | 877-868-9675
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/NURSE
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Name | LEKISHA RUSSELL
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Credential | LPN
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Telephone | 877-868-9675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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