Provider Demographics
NPI:1659133387
Name:CLEVELAND, KORTNEY MONIQUE (NBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:KORTNEY
Middle Name:MONIQUE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 THAYER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2555
Mailing Address - Country:US
Mailing Address - Phone:504-251-9035
Mailing Address - Fax:
Practice Address - Street 1:1100 THAYER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2555
Practice Address - Country:US
Practice Address - Phone:504-251-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA-3813618171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach