Healthcare Provider Details

I. General information

NPI: 1376083931
Provider Name (Legal Business Name): SHANNON LYNNE PUTMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E BEEBE CAPPS EXPY
SEARCY AR
72143-6973
US

IV. Provider business mailing address

2112 CALEB DR
SEARCY AR
72143-3076
US

V. Phone/Fax

Practice location:
  • Phone: 501-278-9679
  • Fax:
Mailing address:
  • Phone: 501-278-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005039
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: