Provider Demographics
NPI:1689495350
Name:COLEMAN, JANIKLA JANTAVEIA
Entity type:Individual
Prefix:
First Name:JANIKLA
Middle Name:JANTAVEIA
Last Name:COLEMAN
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 1:3776 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2132
Mailing Address - Country:US
Mailing Address - Phone:318-670-3159
Mailing Address - Fax:
Practice Address - Street 1:651 GARR RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1145
Practice Address - Country:US
Practice Address - Phone:318-278-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator