Provider Demographics
NPI:1861005860
Name:MOUDY, SHON LINDSAY (APRN)
Entity Type:Individual
Prefix:
First Name:SHON
Middle Name:LINDSAY
Last Name:MOUDY
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:PO BOX 2760
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7704
Mailing Address - Country:US
Mailing Address - Phone:479-282-2966
Mailing Address - Fax:479-282-2967
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 370
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3214
Practice Address - Country:US
Practice Address - Phone:479-282-2966
Practice Address - Fax:479-282-2967
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124245363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics