Provider Demographics
NPI:1083180061
Name:CALDWELL, SHEMIKA NICOLE
Entity Type:Individual
Prefix:
First Name:SHEMIKA
Middle Name:NICOLE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E 70TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5363
Mailing Address - Country:US
Mailing Address - Phone:318-670-7015
Mailing Address - Fax:318-588-7844
Practice Address - Street 1:2100 E 70TH ST STE C
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5363
Practice Address - Country:US
Practice Address - Phone:318-670-7015
Practice Address - Fax:318-588-7844
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
LA220337841073747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty