Provider Demographics
NPI:1003205931
Name:BURNS, SHANTELL (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANTELL
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-1109
Mailing Address - Country:US
Mailing Address - Phone:225-402-2299
Mailing Address - Fax:866-258-9870
Practice Address - Street 1:16270 AIRLINE HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4589
Practice Address - Country:US
Practice Address - Phone:225-402-2299
Practice Address - Fax:866-258-9870
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08173363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health