Provider Demographics
NPI:1306369616
Name:BEAULIEU, SHAMELLE (FNP)
Entity Type:Individual
Prefix:
First Name:SHAMELLE
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-4337
Mailing Address - Country:US
Mailing Address - Phone:225-473-3990
Mailing Address - Fax:
Practice Address - Street 1:8108 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3514
Practice Address - Country:US
Practice Address - Phone:225-473-3990
Practice Address - Fax:225-473-3992
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN136329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily