Healthcare Provider Details

I. General information

NPI: 1962327304
Provider Name (Legal Business Name): SHAUNA RENFROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 OFFICE PARK DR STE 3
BRYANT AR
72022-7536
US

IV. Provider business mailing address

3025 MOUNTAIN VIEW RD
BENTON AR
72019-7849
US

V. Phone/Fax

Practice location:
  • Phone: 501-553-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number219687
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: