Provider Demographics
NPI:1417264706
Name:CARR, SHENEKA
Entity Type:Individual
Prefix:
First Name:SHENEKA
Middle Name:
Last Name:CARR
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 1:58230 BAYOU JACOB RD
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-5237
Mailing Address - Country:US
Mailing Address - Phone:225-636-6532
Mailing Address - Fax:225-766-1545
Practice Address - Street 1:58230 BAYOU JACOB RD
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-5237
Practice Address - Country:US
Practice Address - Phone:225-636-6532
Practice Address - Fax:225-766-1545
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)