Provider Demographics
NPI:1669470563
Name:BALSLEY, SHARON JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JEAN
Last Name:BALSLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2168
Mailing Address - Country:US
Mailing Address - Phone:940-321-3737
Mailing Address - Fax:940-321-3737
Practice Address - Street 1:1201 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4427
Practice Address - Country:US
Practice Address - Phone:817-332-2020
Practice Address - Fax:817-332-4797
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX444487163WX1100X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109900401Medicaid
TX109900401Medicaid
TXR69465Medicare UPIN