Provider Demographics
NPI:1629678768
Name:KLOSKE, SHANA NICHOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:NICHOLE
Last Name:KLOSKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 BAPTIST HEALTH DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6322
Mailing Address - Country:US
Mailing Address - Phone:501-227-0421
Mailing Address - Fax:501-227-0105
Practice Address - Street 1:9600 BAPTIST HEALTH DR STE 320
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6322
Practice Address - Country:US
Practice Address - Phone:501-227-0421
Practice Address - Fax:501-227-0105
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213330363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213330OtherARKANSAS STATE BOARD OF NURSING