Healthcare Provider Details

I. General information

NPI: 1396670121
Provider Name (Legal Business Name): SHELBY TROTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S WALDRON RD
FORT SMITH AR
72903-2556
US

IV. Provider business mailing address

1340 S WALDRON RD
FORT SMITH AR
72903-2556
US

V. Phone/Fax

Practice location:
  • Phone: 479-755-6601
  • Fax: 479-755-6601
Mailing address:
  • Phone: 479-755-6601
  • Fax: 479-755-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203638
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: