Healthcare Provider Details

I. General information

NPI: 1225952765
Provider Name (Legal Business Name): GINA SHELTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5207 W KINGSHIGHWAY
PARAGOULD AR
72450-3430
US

IV. Provider business mailing address

5207 W KINGSHIGHWAY
PARAGOULD AR
72450-3430
US

V. Phone/Fax

Practice location:
  • Phone: 870-215-4400
  • Fax: 870-236-8087
Mailing address:
  • Phone: 870-215-4400
  • Fax: 870-236-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL039749
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: