MEDICARE: KISHA SHUNGA MERRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	PLC9909	LA

General Provider Information

NPI Number	:	1023881869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA SHUNGA MERRICK

Provider Business Mailing Address
First Line	:	11616 SOUTHFORK AVE STE 401
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	318-323-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	11616 SOUTHFORK AVE STE 401
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	318-323-9995
Fax Number	:	318-325-8943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	04/22/2026

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Directions to “ KISHA SHUNGA MERRICK ” Practice Location

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