MEDICARE: SHANNON DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	224959	AR

General Provider Information

NPI Number	:	1558987248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DAVIS RN

Provider Business Mailing Address
First Line	:	502 S MARTIN ST
Second Line	:
City	:	WARREN
State	:	AR
Zip	:	71671-3205
Country	:	US
Telephone Number	:	870-250-0805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 N HILLS BLVD STE 307
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-3757
Country	:	US
Telephone Number	:	501-448-6624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	01/13/2026

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