Individual
M SHANE JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4301 W MARKHAM ST # 584, LITTLE ROCK, AR 72205-7199
(501) 686-8000
(501) 526-5148
Mailing address
4301 W MARKHAM ST # 783, LITTLE ROCK, AR 72205-7199
(501) 686-8000
(501) 526-5148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
04-46598
KS
207P00000X
Emergency Medicine Physician
266197
NY
207P00000X
Emergency Medicine Physician
Primary
E-16517
AR
207P00000X
Emergency Medicine Physician
R0031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03486688
—
NY
05
—
371627601
—
TX
01
—
371627602
CSHCN
TX
Enumeration date
01/12/2009
Last updated
10/07/2024
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