Healthcare Provider Details

I. General information

NPI: 1376055822
Provider Name (Legal Business Name): SHELBY KATELYN MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S ACADIAN THRUWAY
BATON ROUGE LA
70806-6900
US

IV. Provider business mailing address

13626 CANTEBURY AVE
DENHAM SPRINGS LA
70726-7340
US

V. Phone/Fax

Practice location:
  • Phone: 225-831-4998
  • Fax: 225-831-4997
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: