Provider Demographics
NPI:1598845430
Name:SHRUM, DIXIE KAY (AMP)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:KAY
Last Name:SHRUM
Suffix:
Gender:F
Credentials:AMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N MAIN ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2914
Mailing Address - Country:US
Mailing Address - Phone:870-743-4900
Mailing Address - Fax:870-743-4949
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:STE. 1
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2914
Practice Address - Country:US
Practice Address - Phone:870-743-4900
Practice Address - Fax:870-743-4949
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01489 ANP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180884758Medicaid