Provider Demographics
NPI:1790038164
Name:SEWELL, SHELBY A (RNFA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:A
Last Name:SEWELL
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WOODLAND RD APT 507
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3316
Mailing Address - Country:US
Mailing Address - Phone:903-733-7114
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:2700 WOODLAND RD APT 507
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-3316
Practice Address - Country:US
Practice Address - Phone:903-733-7114
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611121163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant