Provider Demographics
NPI:1497021810
Name:SHIELDS, ALFREDA (FNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:ALFREDA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:FNP, PMHNP
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 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4066 DUNNICA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-3510
Practice Address - Country:US
Practice Address - Phone:636-224-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694307363LF0000X
WA61618369363LF0000X
OK222704363LF0000X
MO2020037590363LP0808X
UT14174711-4405363LF0000X
MO2012001249363L00000X, 363LF0000X
OR10032618363LF0000X
AZ330311363LF0000X
AK229519363LF0000X
HI49210363LF0000X
MT243616363LF0000X
NM77844363LF0000X
IL277000588363L00000X
MN2052467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020037590OtherPMHNP
MO2020037590Medicaid