Provider Demographics
NPI:1093265845
Name:COURTNEY, TAMEKA
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:COURTNEY
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 1:3510 LINWOOD AVE # 71103
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4512
Mailing Address - Country:US
Mailing Address - Phone:318-238-3197
Mailing Address - Fax:318-238-3199
Practice Address - Street 1:4019 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109
Practice Address - Country:US
Practice Address - Phone:318-626-5462
Practice Address - Fax:318-626-5562
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator