Provider Demographics
NPI:1154545077
Name:ROYAL, SHIRLENE D (RN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHIRLENE
Middle Name:D
Last Name:ROYAL
Suffix:
Gender:F
Credentials:RN,FNP-C
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Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-0749
Mailing Address - Country:US
Mailing Address - Phone:229-468-9166
Mailing Address - Fax:229-468-9188
Practice Address - Street 1:1309 OCILLA RD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2209
Practice Address - Country:US
Practice Address - Phone:912-384-2252
Practice Address - Fax:912-384-8888
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN077506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000734038HMedicaid