Provider Demographics
NPI:1710621644
Name:LEATHERMAN, MARQUITA KARANIKA KATRELLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:KARANIKA KATRELLE
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MARQUITA
Other - Middle Name:
Other - Last Name:RHYMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30826 LINDER RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-8507
Practice Address - Country:US
Practice Address - Phone:225-665-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator