Healthcare Provider Details

I. General information

NPI: 1104753250
Provider Name (Legal Business Name): SHIRLETA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

207 W CHESTNUT ST
MARIANNA AR
72360-2071
US

IV. Provider business mailing address

PO BOX 2192
FORREST CITY AR
72336-2192
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-2328
  • Fax: 870-662-6826
Mailing address:
  • Phone: 870-630-2328
  • Fax: 870-662-6826

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: