Healthcare Provider Details

I. General information

NPI: 1982539607
Provider Name (Legal Business Name): SHIELEENA KING CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W 3RD ST
CORNING AR
72422-3253
US

IV. Provider business mailing address

1011 W 3RD ST
CORNING AR
72422-3253
US

V. Phone/Fax

Practice location:
  • Phone: 870-634-7328
  • Fax:
Mailing address:
  • Phone: 870-634-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: