Provider Demographics
NPI:1255887550
Name:O'SHIELDS, REBECCA JANE (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:O'SHIELDS
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 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-2023
Practice Address - Street 1:908 N EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101
Practice Address - Country:US
Practice Address - Phone:870-731-0509
Practice Address - Fax:870-731-1019
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216225758Medicaid