Healthcare Provider Details

I. General information

NPI: 1730677675
Provider Name (Legal Business Name): SHEA THOMAS SIMS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N CHURCH ST
JONESBORO AR
72401-1515
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-802-3586
  • Fax: 870-802-2037
Mailing address:
  • Phone: 870-472-5343
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005626
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: