Provider Demographics
NPI:1093699647
Name:MCMINN, SHAWNA (ARPN, IBCLC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:MCMINN
Suffix:
Gender:F
Credentials:ARPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7762 STATE HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:ARBYRD
Mailing Address - State:MO
Mailing Address - Zip Code:63821-9151
Mailing Address - Country:US
Mailing Address - Phone:573-559-6560
Mailing Address - Fax:870-207-0559
Practice Address - Street 1:4334 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6621
Practice Address - Country:US
Practice Address - Phone:870-207-0421
Practice Address - Fax:870-207-0559
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR234274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily