Healthcare Provider Details

I. General information

NPI: 1790732493
Provider Name (Legal Business Name): MISTY L SHATLEY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-3842
  • Fax: 360-462-6952
Mailing address:
  • Phone: 870-735-3842
  • Fax: 360-462-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA234
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: