Healthcare Provider Details

I. General information

NPI: 1811355886
Provider Name (Legal Business Name): KRISTIE WEAVER SHELBIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE D
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

11554 JUBAN PARC AVE
DENHAM SPRINGS LA
70726-6491
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5181
  • Fax:
Mailing address:
  • Phone: 225-773-5682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10394
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10394
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: