Provider Demographics
NPI:1982221438
Name:SHEA, CHRISTEN SEVERSON (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:SEVERSON
Last Name:SHEA
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 1:80 GARDENIA DR STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9196
Mailing Address - Country:US
Mailing Address - Phone:985-871-5900
Mailing Address - Fax:
Practice Address - Street 1:80 GARDENIA DR STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9196
Practice Address - Country:US
Practice Address - Phone:985-898-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily