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General NPI Number Information
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NPI Number | 1962327304
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Entity Type | Individual
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Provider Name | SHAUNA RENFROE
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 408 OFFICE PARK DR STE 3
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City | BRYANT
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State | AR
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Zip | 72022-7536
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Country | US
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Telephone | 501-553-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 MOUNTAIN VIEW RD
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City | BENTON
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State | AR
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Zip | 72019-7849
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 219687
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License Number State | AR
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