| Shannan Souza Aprn Llc | |
|
5150a Sr 247 Pottsville AR 72858-6002 | |
| (479) 567-5680 | |
| (479) 567-5679 |
| Full Name | Shannan Souza Aprn Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5150a Sr 247, Pottsville, Arkansas |
| Authorized Official Name and Position | Shannan Souza (OWNER) |
| Authorized Official Contact | 4794950821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannan Souza Aprn Llc 5150a Sr 247 Pottsville AR 72858-6002 Ph: (479) 567-5680 | Shannan Souza Aprn Llc 5150a Sr 247 Pottsville AR 72858-6002 Ph: (479) 567-5680 |
| NPI Number | 1992421622 |
|---|---|
| Provider Enumeration Date | 10/14/2022 |
| Last Update Date | 11/02/2022 |
| Medicare PECOS PAC ID | 9830566934 |
|---|---|
| Medicare Enrollment ID | O20221102001656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992421622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shannan Deann Souza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831740125 PECOS PAC ID: 0143610311 Enrollment ID: I20211201002707 |
Pottsville Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5395 W Ash St, Pottsville, AR 72858 Phone: 479-880-1118 Fax: 479-880-1120 | |
Souza-townsend Family Medical Clinic, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5150b Sr 247, Pottsville, AR 72858 Phone: 479-567-5680 Fax: 479-567-5679 | |
Wanda Carol Townsend Aprn, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5150b Sr 247, Pottsville, AR 72858 Phone: 479-567-5680 Fax: 479-567-5679 | |
Conway Regional Medical Clinic-pottsville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5395 W Ash St, Suite 2, Pottsville, AR 72858 Phone: 479-880-1118 Fax: 479-219-5013 |