Healthcare Provider Details

I. General information

NPI: 1033219753
Provider Name (Legal Business Name): SHELLY M CLIFTON R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 HIGHWAY 365
MAYFLOWER AR
72106
US

IV. Provider business mailing address

24 SUMMER HILL DR
GREENBRIER AR
72058-9539
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-7413
  • Fax: 501-470-7415
Mailing address:
  • Phone: 501-679-0671
  • Fax: 501-470-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberP00917
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: