Provider Demographics
NPI:1851943567
Name:JOHN, SHEENA LILLIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:LILLIAN
Last Name:JOHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 RVG PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5289
Mailing Address - Country:US
Mailing Address - Phone:214-870-1579
Mailing Address - Fax:
Practice Address - Street 1:141 RVG PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5289
Practice Address - Country:US
Practice Address - Phone:972-923-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant