Healthcare Provider Details

I. General information

NPI: 1184019796
Provider Name (Legal Business Name): KRISTEN J SHEALY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 100
NORTH LITTLE ROCK AR
72117-2905
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-4530
  • Fax: 501-955-4540
Mailing address:
  • Phone: 501-955-4530
  • Fax: 501-955-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-12457
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: