Provider Demographics
NPI:1750311189
Name:WILLERTON, SHARON KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:WILLERTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-428-5750
Mailing Address - Fax:325-428-5769
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1010
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-428-5500
Practice Address - Fax:325-428-5519
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068NAOtherBCBS #
TX042491303Medicaid
TX042491303Medicaid
TXS86004Medicare UPIN