Russell, Shelley W

Russell, Shelley W is an individual health care provider with primary practice located at 2425 Dave Ward Dr Suite 202, Conway AR 72034-8686. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Russell, Shelley W can be contacted via phone (501) 328-5050.

Contact Information

Primary practice address
2425 Dave Ward Dr Suite 202 Conway AR 72034-8686
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X E1574 Arkansas

Profile Details

NPI number 1457330011
LBN Legal business name Russell, Shelley W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2006
Last updated Nov 9th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1457330011 NPPES
Arkansas MEDICAID 140525001

Popular Providers