Provider Demographics
NPI:1558473165
Name:PEARSON, SHANNA L (ANP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BECKY DR
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687-7587
Mailing Address - Country:US
Mailing Address - Phone:870-449-4259
Mailing Address - Fax:870-449-6364
Practice Address - Street 1:707 HIGHWAY 202 W
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-9333
Practice Address - Country:US
Practice Address - Phone:870-449-4259
Practice Address - Fax:870-449-6364
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01210363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP67196Medicare UPIN
AR5X105Medicare PIN