Provider Demographics
NPI:1134875107
Name:SHELMIRE, KRYSTAL (ND)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:
Last Name:SHELMIRE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 WILD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4147
Mailing Address - Country:US
Mailing Address - Phone:337-541-8125
Mailing Address - Fax:
Practice Address - Street 1:201 WESTMARK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7370
Practice Address - Country:US
Practice Address - Phone:337-541-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND989175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath