Healthcare Provider Details

I. General information

NPI: 1801629464
Provider Name (Legal Business Name): SHELBI CONERLY ETTINGER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

IV. Provider business mailing address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

V. Phone/Fax

Practice location:
  • Phone: 225-246-9790
  • Fax: 225-246-9160
Mailing address:
  • Phone: 225-246-9790
  • Fax: 225-246-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23696
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN151866
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: