MEDICARE: SHANNA MCMULLEN MSN, APRN, PMHNP-BC

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	163W00000X	Registered Nurse	RN139294	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	242537	LA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70048766	WA

General Provider Information

NPI Number	:	1932064029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA MCMULLEN MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	3014 DAUPHINE ST STE A
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6755
Country	:	US
Telephone Number	:	504-419-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 RUTH ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-4152
Country	:	US
Telephone Number	:	504-419-3761
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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