Provider Demographics
NPI:1881730190
Name:SHOURD, KATHERINE ELAINE (APN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELAINE
Last Name:SHOURD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SHOURD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:711 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:501-279-9393
Mailing Address - Fax:501-279-9073
Practice Address - Street 1:711 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6964
Practice Address - Country:US
Practice Address - Phone:501-279-9393
Practice Address - Fax:501-279-9073
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02949207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR89-T024OtherMALPRACTICE INSURANCE