Provider Demographics
NPI:1669905279
Name:BROWN, ZAKISHA NATE
Entity type:Individual
Prefix:MS
First Name:ZAKISHA
Middle Name:NATE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KISHA
Other - Middle Name:NATE
Other - Last Name:BLACKSHIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:585 WHITEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4281
Mailing Address - Country:US
Mailing Address - Phone:318-820-7828
Mailing Address - Fax:
Practice Address - Street 1:585 WHITEFIELD LN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4281
Practice Address - Country:US
Practice Address - Phone:318-820-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator