Provider Demographics
NPI:1942963913
Name:CANFIELD, KATELYN MARIE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:CANFIELD
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 1:7591 FERN AVE STE 1703
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5749
Mailing Address - Country:US
Mailing Address - Phone:336-793-0622
Mailing Address - Fax:
Practice Address - Street 1:7591 FERN AVE STE 1703
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5749
Practice Address - Country:US
Practice Address - Phone:336-793-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator