Provider Demographics
NPI:1396824413
Name:FERNALD, SIDNEY STEWART (RN, APN, NP-C, DC)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:STEWART
Last Name:FERNALD
Suffix:
Gender:M
Credentials:RN, APN, NP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S MAIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5441
Mailing Address - Country:US
Mailing Address - Phone:956-631-0142
Mailing Address - Fax:956-618-0446
Practice Address - Street 1:2311 MONACO DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-8471
Practice Address - Country:US
Practice Address - Phone:956-821-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6861111N00000X
TX790354363LF0000X
TXAP-121523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC6861OtherLICENCE NUMBER
TX742920952OtherTAX IDENTIFICATION
TX002110701Medicaid
TX8A1120OtherBCBS PROVIDER
TX609394Medicare ID - Type UnspecifiedMEDICARE
TX002110701Medicaid