Individual provider Active NPI

Lisa J Shackelford, CRNA

  • Certified Registered Nurse Anesthetist
  • Jonesboro, AR
National Provider Identifier
1528074374
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CTP-000011 Issued in AR
Practice address
3024 Stadium Blvd
Jonesboro, AR 72401-7415
Phone
(501) 227-0700
Fax
(501) 227-0744
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X CTP-000011 AR Primary

Addresses

Primary practice location

3024 Stadium Blvd
Jonesboro, AR 72401-7415

Mailing address

304 County Road 388
Jonesboro, AR 72401-0184
Phone (870) 972-5478

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070205000324 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436151453 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelinc Anesthesia V, P.a.Group PAC ID 8921359712, 41 clinicians

Practice addresses (Care Compare)

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-1000

Hospital & facility affiliations

  • Baptist Memorial Hospital Jonesboro, Inc. Hospital, Jonesboro, AR, CCN 040118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
CTP-000011ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Methodist Hospital Corporation CurrentSince Nov 1, 2015 Accepting new patients
Arkansas Methodist Hospital Corporation CurrentSince Nov 1, 2015 Accepting new patients
Wake Up Satisfied PA Nurse Anesthetist, Certified Registered CurrentSince Dec 27, 2023 Accepting new patients
Arkansas Anesthesia Associates, PLLC. CurrentSince Jun 1, 2025 Accepting new patients
Lifelinc Anesthesia V, P.a. Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2020 Accepting new patients

Locations

2241 Hill Park Cv
#B
Jonesboro, AR 72401
Phone (870) 333-5747

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

10301 Kanis Rd
Little Rock, AR 72205
Phone (501) 604-4151

624 Hospital Dr
#4610
Mountain Home, AR 72653
Phone (870) 508-1810

900 W Kingshighway
Paragould, AR 72450
Phone (870) 239-7000

209 S Main St
Poplar Bluff, MO 63901

3340 Players Club Pkwy
Ste 350
Memphis, TN 38125
Phone (901) 207-2017

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528074374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 COUNTY ROAD 388",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724010184",
            "telephone_number": "870-972-5478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 STADIUM BLVD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017415",
            "telephone_number": "501-227-0700",
            "fax_number": "501-227-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "CTP-000011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.