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General NPI Number Information
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NPI Number | 1770172967
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Entity Type | Individual
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Provider Name | SHELLEY BOYTE MAILLHO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 58515 PEARL ACRES RD
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City | SLIDELL
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State | LA
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Zip | 70461-5423
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Country | US
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Telephone | 985-641-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 227 FAYEDAYE DR
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City | MADISONVILLE
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State | LA
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Zip | 70447-3177
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Country | US
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Telephone | 225-955-5381
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Fax |
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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 | 218227
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License Number State | LA
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