Provider Demographics
NPI:1588235121
Name:MCCURTIS, SHATINA LYNIECE (NP)
Entity type:Individual
Prefix:MRS
First Name:SHATINA
Middle Name:LYNIECE
Last Name:MCCURTIS
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 1:888 UNION STATION PKWY APT 4104
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5189
Mailing Address - Country:US
Mailing Address - Phone:405-206-8250
Mailing Address - Fax:
Practice Address - Street 1:7557 RAMBLER RD STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2303
Practice Address - Country:US
Practice Address - Phone:972-837-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty