Provider Demographics
NPI:1205970209
Name:SHIPLEY, DONNA M (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4003 MASSARD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-226-3836
Mailing Address - Fax:479-434-5987
Practice Address - Street 1:4003 MASSARD RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-226-3836
Practice Address - Fax:479-434-5987
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5602207Q00000X
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR169634001Medicaid
OK200202370AMedicaid
AR5AB54Medicare PIN