Provider Demographics
NPI:1285186221
Name:CULLUM-BONNER, SHELLEY ANITA (DNP)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ANITA
Last Name:CULLUM-BONNER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ANITA
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2004 SUBURBAN LN
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6151
Mailing Address - Country:US
Mailing Address - Phone:870-573-0202
Mailing Address - Fax:
Practice Address - Street 1:2004 SUBURBAN LN
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6151
Practice Address - Country:US
Practice Address - Phone:870-573-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9446179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner