Healthcare Provider Details

I. General information

NPI: 1043469869
Provider Name (Legal Business Name): SHAJUANA BOWMAN CHILD CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAJUANA BROWN CHILD CASE MANAGER

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 WEST 5TH ST.
CROSSETT AR
71635
US

IV. Provider business mailing address

790 ROBERTS DR
MONTICELLO AR
71655-5723
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-6471
  • Fax: 870-364-9753
Mailing address:
  • Phone: 870-367-2461
  • Fax: 870-460-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: