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NPI Code Detail

MEDICARE: SHELBY JOHNSON MOUGEOT FNP

MEDICARE: SHELBY JOHNSON MOUGEOT FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner226876LA

General Provider Information

NPI Number : 1457081549
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY JOHNSON MOUGEOT FNP
Provider Business Mailing Address
First Line : 9412 ROUND OAK DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70817-6941
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8333 GOODWOOD BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-7744
Country : US
Telephone Number : 225-272-0106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2022
Last Update Date : 04/12/2023

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