Provider Demographics
NPI:1407564560
Name:GOINES, CARNISHA
Entity Type:Individual
Prefix:
First Name:CARNISHA
Middle Name:
Last Name:GOINES
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:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6068
Mailing Address - Country:US
Mailing Address - Phone:318-210-5289
Mailing Address - Fax:
Practice Address - Street 1:6116 BOWIE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4308
Practice Address - Country:US
Practice Address - Phone:318-210-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy