Provider Demographics
NPI:1609556661
Name:DAVIS, SHONDREIKA TENAE (NP)
Entity Type:Individual
Prefix:
First Name:SHONDREIKA
Middle Name:TENAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WOOD SPGS
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7705
Mailing Address - Country:US
Mailing Address - Phone:318-730-3888
Mailing Address - Fax:
Practice Address - Street 1:316 WOOD SPGS
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7705
Practice Address - Country:US
Practice Address - Phone:318-730-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231770363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health