Healthcare Provider Details

I. General information

NPI: 1548606361
Provider Name (Legal Business Name): ELIZABETH JEAN SHOOK RNP, CS, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 OAKBROOK RD
ALEXANDER AR
72002-9157
US

IV. Provider business mailing address

5510 OAKBROOK RD
ALEXANDER AR
72002-9157
US

V. Phone/Fax

Practice location:
  • Phone: 501-831-2751
  • Fax:
Mailing address:
  • Phone: 501-831-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR19094
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberP01308
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberS01065
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: