Provider Demographics
NPI:1790442200
Name:BURKS, LASHERRICA TARSHAI
Entity Type:Individual
Prefix:
First Name:LASHERRICA
Middle Name:TARSHAI
Last Name:BURKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-2478
Mailing Address - Country:US
Mailing Address - Phone:318-422-7706
Mailing Address - Fax:
Practice Address - Street 1:1516 CLAY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-2478
Practice Address - Country:US
Practice Address - Phone:318-422-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator