Provider Demographics
NPI:1912495532
Name:HENRY, SHAWN ALEXANDER (CRNA)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ALEXANDER
Last Name:HENRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:SCHOONVELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7028 FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-8075
Mailing Address - Country:US
Mailing Address - Phone:501-765-4269
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-552-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003243367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered