Provider Demographics
NPI:1285264549
Name:BATES, SHAMBREL NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAMBREL
Middle Name:NICOLE
Last Name:BATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-4412
Mailing Address - Country:US
Mailing Address - Phone:225-642-9676
Mailing Address - Fax:
Practice Address - Street 1:5760 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:SAINT GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776-4412
Practice Address - Country:US
Practice Address - Phone:225-642-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily