Healthcare Provider Details

I. General information

NPI: 1457518821
Provider Name (Legal Business Name): SHANNON D. EDWARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON D. KOENEMAN MD

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax: 479-338-2906
Mailing address:
  • Phone: 479-443-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-6936
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-6936
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: