MEDICARE: MRS. KATHERINE ELAINE SHOURD APN

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	207RC0000X	Cardiovascular Disease Physician	A02949	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89-T024	OTHER	AR	MALPRACTICE INSURANCE

General Provider Information

NPI Number	:	1881730190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ELAINE SHOURD APN

Provider Business Mailing Address
First Line	:	711 SANTA FE DR
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-6964
Country	:	US
Telephone Number	:	501-279-9393
Fax Number	:	501-279-9073

Provider Business Practice Location Address
First Line	:	711 SANTA FE DR
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-6964
Country	:	US
Telephone Number	:	501-279-9393
Fax Number	:	501-279-9073

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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