Provider Demographics
NPI:1033954359
Name:OWENS, AMBER NICOLE (CPT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:OWENS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 VALLEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-3235
Mailing Address - Country:US
Mailing Address - Phone:318-617-9782
Mailing Address - Fax:
Practice Address - Street 1:2829 YOUREE DR STE 1
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3640
Practice Address - Country:US
Practice Address - Phone:318-617-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLP.204358-PHL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty