MEDICARE: ASHLEY CAROLINE MANNING BOONE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1760278014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY CAROLINE MANNING BOONE

Provider Business Mailing Address
First Line	:	2731 STONE CREEK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-8432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 STONE CREEK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-8432
Country	:	US
Telephone Number	:	318-272-8294
Fax Number	:

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

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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Directions to “ ASHLEY CAROLINE MANNING BOONE ” Practice Location

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