Healthcare Provider Details

I. General information

NPI: 1912752445
Provider Name (Legal Business Name): SHELBY TAYLOR HANSON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 W MAIN ST
RUSSELLVILLE AR
72801-2531
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-500-5001
  • Fax: 501-500-5001
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228090
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: