Provider Demographics
NPI:1609333269
Name:MCKELLER, SHANNA (APN)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:MCKELLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4060
Mailing Address - Country:US
Mailing Address - Phone:501-547-9481
Mailing Address - Fax:501-547-9482
Practice Address - Street 1:201 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4060
Practice Address - Country:US
Practice Address - Phone:501-547-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR079776163WG0000X
ARA006127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice