Healthcare Provider Details

I. General information

NPI: 1598845430
Provider Name (Legal Business Name): DIXIE KAY SHRUM AMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE. 1
HARRISON AR
72601-2914
US

IV. Provider business mailing address

825 N MAIN ST STE. 1
HARRISON AR
72601-2914
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-4900
  • Fax: 870-743-4949
Mailing address:
  • Phone: 870-743-4900
  • Fax: 870-743-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA01489 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: