Healthcare Provider Details

I. General information

NPI: 1811801160
Provider Name (Legal Business Name): ANGEL MICHELLE SHADWICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGEL MICHELLE CROWLEY

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

1355 DAVE WARD DR STE 101
CONWAY AR
72034-7082
US

IV. Provider business mailing address

1355 DAVE WARD DR STE 101
CONWAY AR
72034-7082
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-9782
  • Fax:
Mailing address:
  • Phone: 501-470-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number239697
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: