Healthcare Provider Details

I. General information

NPI: 1619872983
Provider Name (Legal Business Name): JESSICA A SHIELDS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KALISTE SALOOM RD STE 100
LAFAYETTE LA
70508-5784
US

IV. Provider business mailing address

1103 KALISTE SALOOM RD STE 100
LAFAYETTE LA
70508-5784
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-5234
  • Fax:
Mailing address:
  • Phone: 337-234-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA SHIELDS
Title or Position: OWNER
Credential: MD
Phone: 337-315-7927