Healthcare Provider Details

I. General information

NPI: 1205218088
Provider Name (Legal Business Name): SHARON MCMULLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E NORTH ST
MAGNOLIA AR
71753
US

IV. Provider business mailing address

1600 ALDERSGATE RD STE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 870-234-0739
  • Fax:
Mailing address:
  • Phone: 501-661-0720
  • Fax: 501-325-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: