Provider Demographics
NPI:1205565793
Name:LONGORIA, SHAWNA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:LONGORIA
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 1:179 FARRIS LN
Mailing Address - Street 2:
Mailing Address - City:FRIERSON
Mailing Address - State:LA
Mailing Address - Zip Code:71027-2060
Mailing Address - Country:US
Mailing Address - Phone:318-347-6885
Mailing Address - Fax:
Practice Address - Street 1:1505 E BERT KOUN LOOP # 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5723
Practice Address - Country:US
Practice Address - Phone:318-681-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner