Healthcare Provider Details

I. General information

NPI: 1437768447
Provider Name (Legal Business Name): SHEENA RENAYE YOUNGBLOOD APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2020
Last Update Date: 07/26/2020
Certification Date: 07/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E BERT KOUNS INDUSTRIAL LOOP STE 112
SHREVEPORT LA
71105-6810
US

IV. Provider business mailing address

1453 E BERT KOUNS INDUSTRIAL LOOP STE 112
SHREVEPORT LA
71105-6810
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-9400
  • Fax:
Mailing address:
  • Phone: 318-798-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214801
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: