Provider Demographics
NPI:1629658885
Name:WHATLEY, SHANNON M (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:APRN, CNM
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Other - Credentials:
Mailing Address - Street 1:PO BOX 251420
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1420
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:6119 MIDTOWN AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5313
Practice Address - Country:US
Practice Address - Phone:501-296-1800
Practice Address - Fax:501-296-1722
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-08-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife