Provider Demographics
NPI:1861684060
Name:SHEAGREN, PAULETTE LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:LYNN
Last Name:SHEAGREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:L
Other - Last Name:BLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N MILL AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-4273
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:105 N MILL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4273
Practice Address - Country:US
Practice Address - Phone:479-332-0800
Practice Address - Fax:479-332-0801
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR089759163WP0808X
FLRN 2868162163WP0808X
AR217990363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily