Provider Demographics
NPI:1013178938
Name:MEDINA, SHERILYN KAYE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHERILYN
Middle Name:KAYE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHERILYN
Other - Middle Name:KAYE
Other - Last Name:HOLLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-6533
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1735374367500000X
CA3845367500000X
TX836012367500000X
TXAP123857367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323958403Medicaid
TX323958404OtherCSHCN
TX323958403Medicaid