Provider Demographics
NPI:1982201547
Name:CLINE, KEIARA SHERMETRA
Entity Type:Individual
Prefix:MS
First Name:KEIARA
Middle Name:SHERMETRA
Last Name:CLINE
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 1:1351 BURBANK DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2031
Mailing Address - Country:US
Mailing Address - Phone:504-432-0045
Mailing Address - Fax:
Practice Address - Street 1:1351 BURBANK DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2031
Practice Address - Country:US
Practice Address - Phone:504-432-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator