Provider Demographics
NPI:1053652644
Name:MOORE, SHAWNTEL MARIE (ARNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTEL
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W SAINT MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4638
Mailing Address - Country:US
Mailing Address - Phone:337-233-6593
Mailing Address - Fax:337-235-1032
Practice Address - Street 1:300 W SAINT MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4638
Practice Address - Country:US
Practice Address - Phone:337-233-6593
Practice Address - Fax:337-235-1032
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07239363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2348175Medicaid
LA2348175Medicaid