Provider Demographics
NPI:1164882700
Name:PRICE, SHAWNTEL MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTEL
Middle Name:MARIE
Last Name:PRICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-0084
Mailing Address - Country:US
Mailing Address - Phone:870-234-2675
Mailing Address - Fax:870-234-4153
Practice Address - Street 1:1010 N DUDNEY RD STE C
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2651
Practice Address - Country:US
Practice Address - Phone:870-234-2675
Practice Address - Fax:870-234-4153
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily