Shonta Ellison, APRN

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

S002325 Issued in AR

Practice address

130 Lake Valley Dr
Maumelle, AR 72113-5939

Phone

(501) 766-1884

NPI assigned

Sep 24, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1487138608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 LAKE VALLEY DR",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721135939",
            "telephone_number": "501-766-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 LAKE VALLEY DR",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721135939",
            "telephone_number": "501-766-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "SHONTA",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "AR",
            "license": "S002325",
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "AR",
            "license": "S002325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNS",
            "identifier": "S002325",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Olive Faiyengo, PHARMD

• Adult Health Clinical Nurse Specialist in Maumelle, AR
• Providers in Maumelle, AR by specialty
• Adult Health Clinical Nurse Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.