Basic Information
| Provider Information | |||||||||
| NPI: | 1093739286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIPMAN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | DARLENE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E OAK | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356729 | ||||||||
| FaxNumber: | 8702684408 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E OAK | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356729 | ||||||||
| FaxNumber: | 8702684408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RNP609 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | ANP1174 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 364SM0705X | RNP609 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | MS0481678 | 01 | DEA | OTHER |