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General NPI Number Information
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NPI Number | 1053575506
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Entity Type | Individual
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Provider Name | SHANNON EDMONDS ARDOIN MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 44 COLONY RD
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2947
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Country | US
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Telephone | 501-960-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 44 COLONY RD
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2947
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Country | US
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Telephone | 501-960-2422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | E-4819
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD.026096
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License Number State | LA
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