Individual
KIMBERLY K SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 SAINT VINCENT CIR, LITTLE ROCK, AR 72205-5423
(501) 664-4532
(501) 663-4335
Mailing address
500 S UNIVERSITY AVE STE 500, LITTLE ROCK, AR 72205-5307
(501) 664-4532
(501) 663-4335
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
E-3563
AR
207LP2900X
Pain Medicine (Anesthesiology) Physician
E-3563
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03080012900
QUAL CHOICE (LRPM)
AR
01
—
050091824
RAILROAD MEDICARE
AR
01
—
050091825
RAILROAD MEDICARE (LRPM)
AR
05
—
149281001
—
AR
01
—
171973300
US DEPT. OF LABOR OWCP
AR
01
—
5M462
BLUE CROSS BLUE SHIELD
AR
01
—
71033532430
QUAL CHOICE
AR
01
—
770248401
ARKANSAS BREASTCARE
AR
01
—
S02622
NOVASYS
AR
Enumeration date
09/27/2005
Last updated
03/19/2020
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