Provider Demographics
NPI:1669007050
Name:VENABLE, SKYLER
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:VENABLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3452
Mailing Address - Country:US
Mailing Address - Phone:318-505-1353
Mailing Address - Fax:
Practice Address - Street 1:1513 LINE AVENUE
Practice Address - Street 2:SUITE 225
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-7110
Practice Address - Country:US
Practice Address - Phone:318-754-3890
Practice Address - Fax:318-658-9012
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator