Provider Demographics
NPI:1962044263
Name:MILLER, SHAWNA LARAE
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:LARAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 COUNTY ROAD 855
Mailing Address - Street 2:
Mailing Address - City:CARAWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72419-8649
Mailing Address - Country:US
Mailing Address - Phone:870-926-1507
Mailing Address - Fax:
Practice Address - Street 1:1895 COUNTY ROAD 855
Practice Address - Street 2:
Practice Address - City:CARAWAY
Practice Address - State:AR
Practice Address - Zip Code:72419-8649
Practice Address - Country:US
Practice Address - Phone:870-926-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator