NPIMap

Individual provider Active NPI

Shannan Deann Souza, APRN

  • Family Nurse Practitioner
  • Pottsville, AR
National Provider Identifier
1831740125
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F06192213 Issued in AR
Practice address
5150A Sr 247
Pottsville, AR 72858-6002
Phone
(479) 567-5679
Fax
(479) 567-5680
NPI assigned
Sep 27, 2019
Last updated
Nov 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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 F06192213 AR Primary

Addresses

Primary practice location

5150A Sr 247
Pottsville, AR 72858-6002

Mailing address

5150A Sr 247
Pottsville, AR 72858-6002
Phone (479) 567-5679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211201002707 AR Practitioner - Nurse Practitioner 0143610311 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

Practice addresses (Care Compare)

5150 A Sr
Suite 247
Pottsville, AR 72858-6002
Phone (479) 219-3220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F06192213ARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shannan Souza Aprn LLC CurrentSince Nov 1, 2022 Accepting new patients
Premier Pediatrics PLLC PastSince Sep 1, 2019 Accepting new patients

Locations

5150A Sr 247
Pottsville, AR 72858
Phone (479) 219-3220

5150A Sr 247
Ste B
Pottsville, AR 72858

5150B Sr 247
Pottsville, AR 72858
Phone (479) 567-5680

Interoperability endpoints

  • Direct secure messaging: shannan.souza.1@32158.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1831740125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150A SR 247",
            "city": "POTTSVILLE",
            "state": "AR",
            "postal_code": "728586002",
            "telephone_number": "479-567-5679",
            "fax_number": "479-567-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150A SR 247",
            "city": "POTTSVILLE",
            "state": "AR",
            "postal_code": "728586002",
            "telephone_number": "479-567-5679",
            "fax_number": "479-567-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUZA",
        "first_name": "SHANNAN",
        "middle_name": "DEANN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "F06192213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, AR

Sources for this page

Verify at the official NPI Registry.