Provider Demographics
NPI:1710016118
Name:MINOR, KARMELLA DESHONA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KARMELLA
Middle Name:DESHONA
Last Name:MINOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TRISHEKA
Other - Middle Name:AYANNA
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:406 BOYKIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4010
Mailing Address - Country:US
Mailing Address - Phone:985-580-2165
Mailing Address - Fax:
Practice Address - Street 1:406 BOYKIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4010
Practice Address - Country:US
Practice Address - Phone:985-580-2165
Practice Address - Fax:985-223-4424
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 9568171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator