Provider Demographics
NPI:1003389784
Name:KELLY, SHERILYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHERILYN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHERILYN
Other - Middle Name:
Other - Last Name:WIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN NNP-BC FNP-C
Mailing Address - Street 1:2302 PINEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1628
Mailing Address - Country:US
Mailing Address - Phone:435-770-9028
Mailing Address - Fax:
Practice Address - Street 1:7600 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1906
Practice Address - Country:US
Practice Address - Phone:713-790-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140879363LF0000X, 363LN0005X
UT13858013-4405363LF0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily