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General NPI Number Information
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NPI Number | 1245111426
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Entity Type | Individual
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Provider Name | SHAWN MICHAEL RICHARD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 118 ONEIDA WAY
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City | MAUMELLE
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State | AR
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Zip | 72113-5872
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Country | US
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Telephone | 501-353-5765
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Fax |
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Provider Business Mailing Address
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Address Line | 118 ONEIDA WAY
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City | MAUMELLE
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State | AR
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Zip | 72113-5872
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Country | US
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Telephone |
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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 | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | E5344
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License Number State | AR
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