Provider Demographics
NPI:1104309707
Name:SMITH-MCLEAN, SHARIANNE KIONA
Entity type:Individual
Prefix:
First Name:SHARIANNE
Middle Name:KIONA
Last Name:SMITH-MCLEAN
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 1:3625 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2121
Mailing Address - Country:US
Mailing Address - Phone:318-473-4328
Mailing Address - Fax:
Practice Address - Street 1:103 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4025
Practice Address - Country:US
Practice Address - Phone:337-238-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator