Provider Demographics
NPI:1366472839
Name:SHIREY, MICHELLE A (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:SHIREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:MCKANNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657
Mailing Address - Country:US
Mailing Address - Phone:870-367-2461
Mailing Address - Fax:870-367-1690
Practice Address - Street 1:790 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655
Practice Address - Country:US
Practice Address - Phone:870-367-2461
Practice Address - Fax:870-367-1690
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL41417164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse