MEDICARE: SHIRLEY PARNELL RN, CCM, CLCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	R26565	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0430376	OTHER	WA	L&I STATE OF WASHINGTON

General Provider Information

NPI Number	:	1285391805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY PARNELL RN, CCM, CLCP

Provider Business Mailing Address
First Line	:	704 DIVISION ST
Second Line	:
City	:	GREENWOOD
State	:	AR
Zip	:	72936-3609
Country	:	US
Telephone Number	:	479-252-1938
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 DIVISION ST
Second Line	:
City	:	GREENWOOD
State	:	AR
Zip	:	72936-3609
Country	:	US
Telephone Number	:	479-252-1938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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