Provider Demographics
NPI:1740845221
Name:PAILLETT, VILLARY VENITA
Entity type:Individual
Prefix:MS
First Name:VILLARY
Middle Name:VENITA
Last Name:PAILLETT
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 1:9159 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3039
Mailing Address - Country:US
Mailing Address - Phone:318-655-6835
Mailing Address - Fax:
Practice Address - Street 1:9159 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3039
Practice Address - Country:US
Practice Address - Phone:318-655-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007232111172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver