MEDICARE: MS. TASHA LANETTE WILLIAMS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	224P00000X	Prosthetist	LA
2	374U00000X	Home Health Aide
3	224P00000X	Prosthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	224P00000X	OTHER	LA	PROSTHETIST

General Provider Information

NPI Number	:	1972140234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TASHA LANETTE WILLIAMS

Provider Business Mailing Address
First Line	:	6331 WESTPORT AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2415
Country	:	US
Telephone Number	:	318-564-7672
Fax Number	:

Provider Business Practice Location Address
First Line	:	7617 PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3905
Country	:	US
Telephone Number	:	318-564-7672
Fax Number	:

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	07/11/2024

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