Individual provider Active NPI

Shannon Busby, NP

  • Family Nurse Practitioner
  • Conway, AR
National Provider Identifier
1316566607
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
124199 Issued in AR
Practice address
1505 Winterbrook Dr
Conway, AR 72034-3564
Phone
(479) 498-6747
Fax
(479) 968-1673
NPI assigned
Apr 16, 2020
Last updated
Apr 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 124199 AR Primary

Addresses

Primary practice location

1505 Winterbrook Dr
Conway, AR 72034-3564

Mailing address

PO Box 9178
Russellville, AR 72811-9178
Phone (855) 498-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200421001188 AR Practitioner - Nurse Practitioner 1153751854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1065 Skyline Dr
Conway, AR 72032-3530
Phone (501) 499-6222

222 E Dave Ward Dr
Conway, AR 72032-7120
Phone (501) 505-8400

511 W Main St
Russellville, AR 72801-3601
Phone (479) 567-5652

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1316566607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728119178",
            "telephone_number": "855-498-6767",
            "fax_number": "479-968-1673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WINTERBROOK DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343564",
            "telephone_number": "479-498-6747",
            "fax_number": "479-968-1673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSBY",
        "first_name": "SHANNON",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "124199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.