Active NPI
Mary Lynne Shults, PA-C
- Physician Assistant
- Little Rock, AR
National Provider Identifier
1730687450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PT2020-030
- Practice address
- 1 Childrens Way # 653
Little Rock, AR 72202-3500 - Phone
- (501) 364-1100
- Fax
- (501) 364-4082
- NPI assigned
- Jan 28, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 2866 | OK | |
| Physician Assistant | 363A00000X | PT2020-030 | AR | Primary |
Addresses
Primary practice location
1 Childrens Way # 653
Little Rock, AR 72202-3500
Mailing address
1 Childrens Way # 653
Little Rock, AR 72202-3500
Phone (501) 364-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2866 | OK | MD | Speech-Language Pathologist |
| PT2020-030 | AR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Childrens Hospital | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Dental Clinic/Center
- Little Rock, AR
- NPI 1770889552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587340800000",
"number": "1730687450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHILDRENS WAY # 653",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722023500",
"telephone_number": "501-364-1100",
"fax_number": "501-364-4082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS WAY # 653",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722023500",
"telephone_number": "501-364-1100",
"fax_number": "501-364-4082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULTS",
"first_name": "MARY",
"middle_name": "LYNNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-28",
"last_updated": "2020-04-20",
"certification_date": "2020-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "OK",
"license": "2866",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AR",
"license": "PT2020-030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.