Provider Demographics
NPI:1073978144
Name:HALTOM-WILSON, SHEILA CHAREE (APN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:CHAREE
Last Name:HALTOM-WILSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:CHAREE
Other - Last Name:HALTOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:701 TUSCAN DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3838
Practice Address - Country:US
Practice Address - Phone:214-496-1100
Practice Address - Fax:214-496-1110
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128589363LF0000X
TX627947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily