MEDICARE: MISS GABRIELLE MICHELLE THOMAS

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

General Provider Information

NPI Number	:	1942833892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GABRIELLE MICHELLE THOMAS

Provider Business Mailing Address
First Line	:	2020 E 70TH ST STE 301
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-5332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 HOLLYWOOD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3864
Country	:	US
Telephone Number	:	318-347-0655
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	04/13/2023

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