Healthcare Provider Details

I. General information

NPI: 1225966229
Provider Name (Legal Business Name): SHANNON HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W MARKHAM ST
LITTLE ROCK AR
72201-1306
US

IV. Provider business mailing address

12 ROCKY VALLEY CV
LITTLE ROCK AR
72212-3172
US

V. Phone/Fax

Practice location:
  • Phone: 501-447-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: