Provider Information for 1407513567
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JERRIE MILES BOOKER
Sex: Female
NPI: 1407513567
Last Updated: 2024-11-25
Certification Date: 2024-11-25
Certification Date: 2024-11-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1407513567 | ||||||||
| Enumeration Date | 2021-11-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9403 MANSFIELD RD SHREVEPORT, LA 71118-3815 United States Phone: 318-861-8938 | Fax: | ||||||||
| Primary Practice Address | 13910 ALBA DR BAKER, LA 70714-4616 United States Phone: 225-931-0630 | Fax: | ||||||||
| Secondary Practice Address(es) | 3084 WESTFORK DR STE C | ||||||||
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