Provider Demographics
NPI:1023560042
Name:SHEETS, DEWEY WAYNE
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:WAYNE
Last Name:SHEETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5467 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-7811
Mailing Address - Country:US
Mailing Address - Phone:417-206-2057
Mailing Address - Fax:417-206-2057
Practice Address - Street 1:5467 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-7811
Practice Address - Country:US
Practice Address - Phone:417-206-2057
Practice Address - Fax:417-206-2057
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor