Provider Demographics
NPI:1851397020
Name:LEBLANC, SHELLEY D (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:D
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3628
Mailing Address - Country:US
Mailing Address - Phone:337-824-6150
Mailing Address - Fax:337-824-6152
Practice Address - Street 1:1914 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3628
Practice Address - Country:US
Practice Address - Phone:337-824-6150
Practice Address - Fax:337-824-6152
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN075272-AP03656363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432377Medicaid
LAP11713Medicare UPIN
LA1432377Medicaid