Provider Demographics
NPI:1497797187
Name:SHEETS, STEPHENA M (CNS)
Entity Type:Individual
Prefix:
First Name:STEPHENA
Middle Name:M
Last Name:SHEETS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8820 S MERIDIAN ST
Practice Address - Street 2:STE 225
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6064
Practice Address - Country:US
Practice Address - Phone:317-865-6922
Practice Address - Fax:317-865-6930
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000051A363LP0808X
IN70000051364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00924301OtherRAILROAD MEDICARE PTAN
INP00924301OtherRAILROAD MEDICARE PTAN
INM400015333Medicare PIN
INS86340Medicare UPIN