Healthcare Provider Details

I. General information

NPI: 1841617453
Provider Name (Legal Business Name): CONSTANCE SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 ROSELAWN CIR
WEST MEMPHIS AR
72301-2842
US

IV. Provider business mailing address

1014 ROSELAWN CIR
WEST MEMPHIS AR
72301-2842
US

V. Phone/Fax

Practice location:
  • Phone: 870-225-1068
  • Fax:
Mailing address:
  • Phone:
  • 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: