Provider Demographics
NPI:1275562258
Name:SHIPMAN, LELA R (MNSC, RN, APN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LELA
Middle Name:R
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:MNSC, RN, APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6233
Mailing Address - Country:US
Mailing Address - Phone:479-751-8440
Mailing Address - Fax:479-751-8417
Practice Address - Street 1:1110 W ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6233
Practice Address - Country:US
Practice Address - Phone:479-751-8440
Practice Address - Fax:479-751-8417
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1275562258OtherBC/BS
ARR25874OtherRN LICENSE NUMBER
ARA01150OtherAPN LICENSE NUMBER
AR132047758Medicaid
AR132047758Medicaid