Provider Demographics
NPI:1497703219
Name:SPEARS-SHEA, KELLY A (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SPEARS-SHEA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CAGLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8380
Mailing Address - Country:US
Mailing Address - Phone:817-255-1940
Mailing Address - Fax:817-255-1977
Practice Address - Street 1:4300 CAGLE DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8380
Practice Address - Country:US
Practice Address - Phone:817-255-1940
Practice Address - Fax:817-255-1977
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189628401Medicaid
TX041592904Medicaid
TX041592910Medicaid
TX041592902Medicaid
TX041592909Medicaid
TX041592903Medicaid
TX041592908Medicaid
TX8K0598Medicare PIN
TXTXB102680Medicare PIN
TX189628401Medicaid
TX8K0597Medicare PIN
TX041592908Medicaid
TX8K0596Medicare PIN
TXTXB102687Medicare PIN
TXTXB102695Medicare PIN