Provider Demographics
NPI:1932404159
Name:CARTINEZ, SHELLEY LEANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LEANNE
Last Name:CARTINEZ
Suffix:
Gender:F
Credentials:FNP
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 130
Mailing Address - Street 2:
Mailing Address - City:NEW LLANO
Mailing Address - State:LA
Mailing Address - Zip Code:71461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 S. HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449
Practice Address - Country:US
Practice Address - Phone:318-431-5100
Practice Address - Fax:318-808-7007
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner