Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP08173 | LA |
NPI | 1003205931 |
---|---|
Provider Name | Dr. Shantell Burns |
First Address | Prairieville, LA 70769-1109 |
Second Address | Prairieville, LA 70769-4589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 05/05/2021 |