Basic Information
| Provider Information | |||||||||
| NPI: | 1801510235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPAULDING | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 WOODHAVEN RD | ||||||||
| Address2: | |||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705926283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083906186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 536 VETERANS MEMORIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378267702 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2022 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 227434 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 227434 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.