Healthcare Provider Details

I. General information

NPI: 1588496269
Provider Name (Legal Business Name): SHAWNA M WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAWNA M STOVALL RN

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HAYDEN WARD LN
AMITY AR
71921-8502
US

IV. Provider business mailing address

19 HAYDEN WARD LN
AMITY AR
71921-8502
US

V. Phone/Fax

Practice location:
  • Phone: 870-260-8045
  • Fax:
Mailing address:
  • Phone: 870-260-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR099337
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR099337
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR099337
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: