Provider Demographics
NPI:1912487869
Name:SHAPPLEY, ANNSLEY WALDEN
Entity type:Individual
Prefix:
First Name:ANNSLEY
Middle Name:WALDEN
Last Name:SHAPPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNSLEY
Other - Middle Name:KATE
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST STE 355
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:920 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-807-6267
Practice Address - Fax:318-812-6458
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2479466Medicaid