Provider Demographics
NPI:1467230334
Name:SNOW, SHELBY JAE (CNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JAE
Last Name:SNOW
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-8039
Mailing Address - Country:US
Mailing Address - Phone:501-499-5068
Mailing Address - Fax:
Practice Address - Street 1:11001 EXECUTIVE CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4300
Practice Address - Country:US
Practice Address - Phone:501-202-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily