Provider Demographics
NPI:1346776887
Name:WHEELER, CIERRA
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:WHEELER
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 1:8532 BETTY SMOTHERS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-2468
Mailing Address - Country:US
Mailing Address - Phone:225-772-8430
Mailing Address - Fax:
Practice Address - Street 1:9420 LINDALE AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4161
Practice Address - Country:US
Practice Address - Phone:225-442-3540
Practice Address - Fax:225-442-3546
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13855104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000Medicaid