Provider Demographics
NPI:1356521553
Name:STEWARD, SHANTINA MICHELLE
Entity type:Individual
Prefix:MS
First Name:SHANTINA
Middle Name:MICHELLE
Last Name:STEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LAFAYETTE 39
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:AR
Mailing Address - Zip Code:71827-9505
Mailing Address - Country:US
Mailing Address - Phone:870-953-0045
Mailing Address - Fax:
Practice Address - Street 1:70 LAFAYETTE 39 LOT B
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:AR
Practice Address - Zip Code:71827-9505
Practice Address - Country:US
Practice Address - Phone:870-949-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR72626101YM0800X
AR216710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health