Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A004979 | AR |
NPI | 1003352444 |
---|---|
Provider Name | Ashley Dawn Shrives |
First Address | Weiner, AR 72479-9289 |
Second Address | Dardanelle, AR 72834-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A004979 | STATE LICENSE (01) | AR |