Provider Demographics
NPI:1376258319
Name:SHIELDS, JENNIFER PARRETT
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PARRETT
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ROBERT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2005
Mailing Address - Country:US
Mailing Address - Phone:985-768-0977
Mailing Address - Fax:
Practice Address - Street 1:1150 ROBERT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2005
Practice Address - Country:US
Practice Address - Phone:985-646-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily