Provider Demographics
NPI:1245772573
Name:DENNIS, JASHEIKA (MHP)
Entity Type:Individual
Prefix:
First Name:JASHEIKA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 COBURN LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6010
Mailing Address - Country:US
Mailing Address - Phone:318-762-1225
Mailing Address - Fax:
Practice Address - Street 1:2419 COBURN LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6010
Practice Address - Country:US
Practice Address - Phone:318-762-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA811240931Medicaid