Healthcare Provider Details

I. General information

NPI: 1538610316
Provider Name (Legal Business Name): SHARONDA SMARJESSE LONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S BOWMAN RD STE 4
LITTLE ROCK AR
72211-3427
US

IV. Provider business mailing address

921 SHEPHARD DR
WHITE HALL AR
71602-5432
US

V. Phone/Fax

Practice location:
  • Phone: 501-246-3423
  • Fax:
Mailing address:
  • Phone: 501-766-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-698
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: