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1417192774 NPI number — SHEA S ARNOLD PA-C

NPI Number: 1417192774
Health Care Provider/Practitioner: SHEA S ARNOLD PA-C

Information about “1417192774” NPI (SHEA S ARNOLD PA-C) exists in 1417192774 in HTML format HTML  |  1417192774 in plain Text format TXT  |  1417192774 in PDF (Portable Document Format) PDF  |  1417192774 in an XML format XML  formats.

NPI Number : 1417192774 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417192774",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ARNOLD",
    "FirstName": "SHEA",
    "MiddleName": "S",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SALLEY",
    "OtherFirstName": "SHEA",
    "OtherMiddleName": "AMBER",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2708 S RIFE MEDICAL LN",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "ROGERS",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72758-1452",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-338-3030",
    "MailingAddressFaxNumber": "479-338-3079",
    "FirstLinePracticeLocationAddress": "2708 S RIFE MEDICAL LN",
    "SecondLinePracticeLocationAddress": "SUITE 300",
    "PracticeLocationAddressCityName": "ROGERS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72758-1452",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-338-3030",
    "PracticeLocationAddressFaxNumber": "479-338-3079",
    "EnumerationDate": "12/15/2008",
    "LastUpdateDate": "09/15/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "PA-328",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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