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General NPI Number Information
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NPI Number | 1285398131
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Entity Type | Individual
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Provider Name | SHAWNA LYNN LASATER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 296 INGRAM ST STE A
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City | CLINTON
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State | AR
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Zip | 72031-7087
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Country | US
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Telephone | 501-215-0318
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Fax | 501-200-5501
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Provider Business Mailing Address
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Address Line | 296 INGRAM ST STE A
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City | CLINTON
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State | AR
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Zip | 72031-7087
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Country | US
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Telephone | 501-215-0318
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Fax | 501-200-5501
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 217856
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | R085008
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License Number State | AR
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