Healthcare Provider Details

I. General information

NPI: 1457977431
Provider Name (Legal Business Name): SHELBY GAIL FOSHEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OLD HIGHWAY 70 W
DIERKS AR
71833-8828
US

IV. Provider business mailing address

422 ALLEN CEMETARY RD
DIERKS AR
71833-9501
US

V. Phone/Fax

Practice location:
  • Phone: 870-286-3234
  • Fax:
Mailing address:
  • Phone: 870-260-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: