Healthcare Provider Details

I. General information

NPI: 1801510235
Provider Name (Legal Business Name): SHELLY MARIE SPAULDING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 VETERANS MEMORIAL BLVD
WASHINGTON LA
70589
US

IV. Provider business mailing address

111 WOODHAVEN RD
YOUNGSVILLE LA
70592-6283
US

V. Phone/Fax

Practice location:
  • Phone: 337-826-7702
  • Fax:
Mailing address:
  • Phone: 308-390-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227434
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number227434
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: