Basic Information
| Provider Information | |||||||||
| NPI: | 1184015919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFEY | ||||||||
| FirstName: | SHIRLEY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6751 FRONTIER DR | ||||||||
| Address2: | |||||||||
| City: | GREENWELL SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707393105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812621 | ||||||||
| FaxNumber: | 2253816131 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 NORTH BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812621 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN126258 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | RN 126258 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | AP08235 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2384163 | 05 | LA | MEDICAID |