Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | AP09681 | LA |
Y | 363L00000X | Nurse Practitioner | APO9681 | LA |
NPI | 1023506862 |
---|---|
Provider Name | Keisha Roichelle Bonyfield |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 29/06/2018 |