1013291350 NPI number — MRS. SHELLY SEBASTIEN RICHARD ANP,C

Table of content: MRS. SHELLY SEBASTIEN RICHARD ANP,C (NPI 1013291350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013291350 NPI number — MRS. SHELLY SEBASTIEN RICHARD ANP,C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARD
Provider First Name:
SHELLY
Provider Middle Name:
SEBASTIEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP,C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013291350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 WEST SAINT MARY BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-470-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W SAINT MARY BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-470-4500
Provider Business Practice Location Address Fax Number:
337-470-4515
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN100570-AP06654 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP06654 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2170082 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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