Healthcare Provider Details

I. General information

NPI: 1619460813
Provider Name (Legal Business Name): ALISON HOBSON SHEPHERD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 HOLIDAY DR STE 404
FORREST CITY AR
72335-9157
US

IV. Provider business mailing address

49 COUNTY ROAD 7429
WYNNE AR
72396-5005
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-0215
  • Fax:
Mailing address:
  • Phone: 870-270-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberATP001299
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: