Provider Demographics
NPI:1720974470
Name:ONEAL DIRECT HEALTH
Entity type:Organization
Organization Name:ONEAL DIRECT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-302-5453
Mailing Address - Street 1:8702 GLEN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6222
Mailing Address - Country:US
Mailing Address - Phone:337-302-5453
Mailing Address - Fax:318-725-3505
Practice Address - Street 1:818 MONTROSE DR STE B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2012
Practice Address - Country:US
Practice Address - Phone:337-302-5453
Practice Address - Fax:337-302-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1275929929OtherSTATE
LA1275929929Medicaid