Provider Demographics
NPI:1710474242
Name:FINE, SHAYLA R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:R
Last Name:FINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:79525-3127
Mailing Address - Country:US
Mailing Address - Phone:325-660-0795
Mailing Address - Fax:
Practice Address - Street 1:1712 N ACCESS RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-3352
Practice Address - Country:US
Practice Address - Phone:325-893-4010
Practice Address - Fax:325-893-4042
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner