Provider Demographics
NPI:1255949921
Name:MOE, SHANNON L (RN, APRN FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MOE
Suffix:
Gender:
Credentials:RN, APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-0310
Mailing Address - Country:US
Mailing Address - Phone:318-237-1344
Mailing Address - Fax:
Practice Address - Street 1:1514 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3379
Practice Address - Country:US
Practice Address - Phone:318-549-2500
Practice Address - Fax:318-549-2555
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN119419163WH0200X
LA214569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health