Provider Demographics
NPI:1376083931
Name:PUTMAN, SHANNON LYNNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNNE
Last Name:PUTMAN
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 1:2112 CALEB DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-3076
Mailing Address - Country:US
Mailing Address - Phone:501-278-9679
Mailing Address - Fax:
Practice Address - Street 1:1905 E BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6973
Practice Address - Country:US
Practice Address - Phone:501-278-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily