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General NPI Number Information
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NPI Number | 1164771473
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Entity Type | Individual
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Provider Name | AMY SHEPHERD PRUDEN APRN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 2647 S SAINT ELIZABETH BLVD STE 308
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City | GONZALES
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State | LA
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Zip | 70737-5020
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Country | US
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Telephone | 225-765-5500
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Fax | 225-765-9419
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Provider Business Mailing Address
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Address Line | 5959 S SHERWOOD FOREST BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-6038
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Country | US
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Telephone | 225-765-5500
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Fax | 225-765-9196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP07035
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License Number State | LA
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