Provider Demographics
NPI:1104246545
Name:FAULKINBERRY, SHANNON RENEE (MD, MPH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:FAULKINBERRY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2510 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3119
Mailing Address - Country:US
Mailing Address - Phone:318-212-5665
Mailing Address - Fax:318-212-5698
Practice Address - Street 1:2510 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3119
Practice Address - Country:US
Practice Address - Phone:318-212-5665
Practice Address - Fax:318-212-5698
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1444002080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine