Provider Demographics
NPI:1013291350
Name:RICHARD, SHELLY SEBASTIEN (ANP,C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:SEBASTIEN
Last Name:RICHARD
Suffix:
Gender:F
Credentials:ANP,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WEST SAINT MARY BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-470-4500
Mailing Address - Fax:
Practice Address - Street 1:501 W SAINT MARY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4665
Practice Address - Country:US
Practice Address - Phone:337-470-4500
Practice Address - Fax:337-470-4515
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN100570-AP06654363LA2200X
LAAP06654363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2170082Medicaid