Provider Demographics
NPI:1982311098
Name:OWENS DAVIS, MONICA YVETTE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:YVETTE
Last Name:OWENS DAVIS
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 1:1049 WOODSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2848
Mailing Address - Country:US
Mailing Address - Phone:318-678-8852
Mailing Address - Fax:
Practice Address - Street 1:1049 WOODSHIRE CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2848
Practice Address - Country:US
Practice Address - Phone:318-678-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator