Healthcare Provider Details

I. General information

NPI: 1770898264
Provider Name (Legal Business Name): CHRYSTAL LYNN SHETRON MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRYSTAL MORRISON

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST
NORTH LITTLE ROCK AR
72114-9909
US

IV. Provider business mailing address

301 MAIN ST STE 206
NORTH LITTLE ROCK AR
72114-4918
US

V. Phone/Fax

Practice location:
  • Phone: 866-700-1606
  • Fax:
Mailing address:
  • Phone: 866-700-1606
  • Fax:

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: