Healthcare Provider Details

I. General information

NPI: 1124258553
Provider Name (Legal Business Name): SHELLIA ANNE KORNEGAY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W HOLLAND AVE STE 202
WHITE HALL AR
71602-9221
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-619-4451
  • Fax: 870-247-7089
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAO3247
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: