Healthcare Provider Details

I. General information

NPI: 1265346589
Provider Name (Legal Business Name): SHANNON HOWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GALINA ST
BEEBE AR
72012-3812
US

IV. Provider business mailing address

503 GALINA ST
BEEBE AR
72012-3812
US

V. Phone/Fax

Practice location:
  • Phone: 501-239-3353
  • Fax: 501-232-5057
Mailing address:
  • Phone: 501-239-3353
  • Fax: 501-232-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: