Healthcare Provider Details

I. General information

NPI: 1932064029
Provider Name (Legal Business Name): SHANNA MCMULLEN MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 DAUPHINE ST STE A #240308
NEW ORLEANS LA
70117-6755
US

IV. Provider business mailing address

3014 DAUPHINE ST STE A #240308
NEW ORLEANS LA
70117-6755
US

V. Phone/Fax

Practice location:
  • Phone: 504-419-3761
  • Fax: 504-419-3761
Mailing address:
  • Phone: 504-419-3761
  • Fax: 504-419-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242537
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70048766
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN139294
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: