Healthcare Provider Details

I. General information

NPI: 1699123562
Provider Name (Legal Business Name): SHANNON CASTLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 HIGHWAY 62 65 N STE 1
HARRISON AR
72601-1922
US

IV. Provider business mailing address

PO BOX 707
MOUNTAIN HOME AR
72654-0707
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-6111
  • Fax: 870-741-6109
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216332
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: