Provider Demographics
NPI:1295479996
Name:SMITH, ALONQUINETTE (MA)
Entity type:Individual
Prefix:
First Name:ALONQUINETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 W CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-4635
Mailing Address - Country:US
Mailing Address - Phone:404-448-8757
Mailing Address - Fax:
Practice Address - Street 1:3940 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109
Practice Address - Country:US
Practice Address - Phone:404-448-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010175617Medicaid