Provider Demographics
NPI:1215512686
Name:MINGO, ALICIA (LPN, CCHC, CBS, CBE,)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:LPN, CCHC, CBS, CBE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 TEXAS AVE UNIT 38602
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-5116
Mailing Address - Country:US
Mailing Address - Phone:318-219-6640
Mailing Address - Fax:
Practice Address - Street 1:9250 DEAN RD APT 2112
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2851
Practice Address - Country:US
Practice Address - Phone:318-219-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 174N00000X
LA374J00000X
LA20160175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty