Healthcare Provider Details

I. General information

NPI: 1376111500
Provider Name (Legal Business Name): SHYNI JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

IV. Provider business mailing address

3801 SW POST LOOP APT 4
BENTONVILLE AR
72713-2083
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-6000
  • Fax:
Mailing address:
  • Phone: 479-402-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215167
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: