Provider Demographics
NPI:1740574979
Name:HILL, SHANON RENEE (APN)
Entity type:Individual
Prefix:
First Name:SHANON
Middle Name:RENEE
Last Name:HILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SHANON
Other - Middle Name:
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8007 RIDGESTONE CV
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-9276
Mailing Address - Country:US
Mailing Address - Phone:501-847-8024
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 512
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03554 ANP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal