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NPI Code Detail

MEDICARE: SHONTAE MARIE JETT

MEDICARE: SHONTAE MARIE JETT
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
1171M00000XCase Manager/Care CoordinatorLA

General Provider Information

NPI Number : 1952266082
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHONTAE MARIE JETT
Provider Business Mailing Address
First Line : 6015 HEARNE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71108-3803
Country : US
Telephone Number : 318-213-0904
Fax Number : 318-213-0905
Provider Business Practice Location Address
First Line : 6015 HEARNE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71108-3803
Country : US
Telephone Number : 318-213-0904
Fax Number : 318-213-0905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2025
Last Update Date : 12/20/2025

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Directions to “ SHONTAE MARIE JETT ” Practice Location

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