Healthcare Provider Details

I. General information

NPI: 1053005785
Provider Name (Legal Business Name): SHELBY ANN VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PONCE DE LEON DR
HOT SPRINGS AR
71909-8121
US

IV. Provider business mailing address

5125 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5315
US

V. Phone/Fax

Practice location:
  • Phone: 501-922-2217
  • Fax:
Mailing address:
  • Phone: 12-241-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224155
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: