Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP06654 | LA |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN100570-AP06654 | LA |
NPI | 1013291350 |
---|---|
Provider Name | Mrs. Shelly Sebastien Richard |
First Address | Lafayette, LA 70506 |
Second Address | Lafayette, LA 70506-4665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2170082 | (05) | LA |