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General NPI Number Information
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NPI Number | 1558810937
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Entity Type | Organization
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Legal Business Name | SAS-APN LLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 5304 BRYANT PL
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City | SPRINGDALE
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State | AR
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Zip | 72764-2585
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Country | US
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Telephone | 479-841-6145
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Fax |
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Provider Business Mailing Address
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Address Line | 5304 BRYANT PL
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City | SPRINGDALE
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State | AR
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Zip | 72764-2585
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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 | PRESIDENT
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Name | SAMANTHA SHEPHERD
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Credential | APN
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Telephone | 479-841-6145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A001601/R048952
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License Number State | AR
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