Healthcare Provider Details

I. General information

NPI: 1740574979
Provider Name (Legal Business Name): SHANON RENEE HILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANON STROUD

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

8007 RIDGESTONE CV
ALEXANDER AR
72002-9276
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-7088
  • Fax:
Mailing address:
  • Phone: 501-847-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberA03554 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: