Provider Demographics
NPI:1245540137
Name:SHORT, SUSAN MICHELLE (FNPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5330
Mailing Address - Country:US
Mailing Address - Phone:817-447-1208
Mailing Address - Fax:817-447-1106
Practice Address - Street 1:434 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5330
Practice Address - Country:US
Practice Address - Phone:817-447-1208
Practice Address - Fax:817-447-1106
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628756363LF0000X
TXAP115646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily