Provider Demographics
NPI:1003352444
Name:SHRIVES, ASHLEY DAWN (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:SHRIVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:RHINEHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WEINER
Mailing Address - State:AR
Mailing Address - Zip Code:72479-9289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1176 STATE HIGHWAY 22 W
Practice Address - Street 2:SUITE B
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3006
Practice Address - Country:US
Practice Address - Phone:870-605-0014
Practice Address - Fax:870-994-7488
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004979OtherSTATE LICENSE