Provider Demographics
NPI:1063829893
Name:BATES, SHELITA JUANIX (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELITA
Middle Name:JUANIX
Last Name:BATES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0018
Mailing Address - Fax:225-765-9468
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 1009
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-5858
Practice Address - Fax:225-765-5859
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily