Healthcare Provider Details

I. General information

NPI: 1336533140
Provider Name (Legal Business Name): ANNE SHEEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

IV. Provider business mailing address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-4451
  • Fax: 479-718-1330
Mailing address:
  • Phone: 479-575-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-610
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: