Provider Demographics
NPI:1659987527
Name:ONEAL, SHANDI LYNN
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:LYNN
Last Name:ONEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANDI
Other - Middle Name:LYNN
Other - Last Name:WILLMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:416 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-9182
Mailing Address - Country:US
Mailing Address - Phone:870-997-7386
Mailing Address - Fax:
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7752
Practice Address - Country:US
Practice Address - Phone:501-321-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily