Provider Demographics
NPI:1346903705
Name:SHERIDAN, AMY (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8467
Mailing Address - Country:US
Mailing Address - Phone:903-731-5267
Mailing Address - Fax:903-731-5249
Practice Address - Street 1:4000 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8467
Practice Address - Country:US
Practice Address - Phone:903-731-5267
Practice Address - Fax:903-731-5249
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142105363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily