Provider Demographics
NPI:1952074858
Name:GAINES, CIERRA MONET
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:MONET
Last Name:GAINES
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 1:9111 INTERLINE AVE STE 17A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1979
Mailing Address - Country:US
Mailing Address - Phone:122-561-5728
Mailing Address - Fax:
Practice Address - Street 1:10284 W WINSTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2536
Practice Address - Country:US
Practice Address - Phone:318-416-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator