Provider Demographics
NPI:1285391805
Name:PARNELL, SHIRLEY (RN, CCM, CLCP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:PARNELL
Suffix:
Gender:F
Credentials:RN, CCM, CLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-3609
Mailing Address - Country:US
Mailing Address - Phone:479-252-1938
Mailing Address - Fax:
Practice Address - Street 1:704 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3609
Practice Address - Country:US
Practice Address - Phone:479-252-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR26565163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0430376OtherL&I STATE OF WASHINGTON