Individual
KASILYNN ALESE SHADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 W SUNSET AVE, SPRINGDALE, AR 72762-4950
(479) 717-7089
Mailing address
3300 W SUNSET AVE, SPRINGDALE, AR 72762-4950
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
125710
AR
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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