Provider Demographics
NPI:1063283646
Name:PERRY, SHELIA KATHELEEN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:KATHELEEN
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:SHELIA
Other - Middle Name:
Other - Last Name:EZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3611
Mailing Address - Country:US
Mailing Address - Phone:318-237-9924
Mailing Address - Fax:
Practice Address - Street 1:804 POLK ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2350
Practice Address - Country:US
Practice Address - Phone:318-435-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA233933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily