MEDICARE: SHELITA SPEARS KING FNP-C

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
1	363LF0000X	Family Nurse Practitioner	200698	LA

General Provider Information

NPI Number	:	1750854311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELITA SPEARS KING FNP-C

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	844-630-0700
Fax Number	:	877-374-1924

Provider Business Practice Location Address
First Line	:	6404 GROOM RD
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-4364
Country	:	US
Telephone Number	:	225-614-9065
Fax Number	:	877-270-0561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	02/19/2025

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Directions to “ SHELITA SPEARS KING FNP-C” Practice Location

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