Provider Demographics
NPI:1083313761
Name:SHEARER, MISTY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:SHEARER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:18451 E AUBREY GLEN RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3626
Mailing Address - Country:US
Mailing Address - Phone:480-332-9729
Mailing Address - Fax:
Practice Address - Street 1:21772 S ELLSWORTH LOOP RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7709
Practice Address - Country:US
Practice Address - Phone:480-512-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN151875163WE0003X
AZ289235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency