Provider Demographics
NPI:1679708176
Name:WASSON, SHELLEY (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2107
Mailing Address - Country:US
Mailing Address - Phone:479-420-6497
Mailing Address - Fax:479-484-5619
Practice Address - Street 1:508 6TH ST
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2107
Practice Address - Country:US
Practice Address - Phone:479-420-6497
Practice Address - Fax:479-484-5619
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR012008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife