Provider Demographics
NPI:1366338261
Name:SHACKLEFORD, LOREN CARIE
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:CARIE
Last Name:SHACKLEFORD
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 1:1086 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:LA
Mailing Address - Zip Code:71447-4012
Mailing Address - Country:US
Mailing Address - Phone:318-969-9169
Mailing Address - Fax:
Practice Address - Street 1:710 VERSAILLES BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2351
Practice Address - Country:US
Practice Address - Phone:318-449-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator