Provider Demographics
NPI:1801510235
Name:SPAULDING, SHELLY MARIE (NP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WOODHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6283
Mailing Address - Country:US
Mailing Address - Phone:308-390-6186
Mailing Address - Fax:
Practice Address - Street 1:536 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:LA
Practice Address - Zip Code:70589
Practice Address - Country:US
Practice Address - Phone:337-826-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227434207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine