Provider Demographics
NPI:1295247096
Name:STEWART, SHAYLA BLACKWELL (FNP)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:BLACKWELL
Last Name:STEWART
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 1:2800 E BROAD ST STE 504
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6417
Mailing Address - Country:US
Mailing Address - Phone:817-225-0410
Mailing Address - Fax:817-453-8866
Practice Address - Street 1:2800 E BROAD ST STE 504
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-225-0410
Practice Address - Fax:817-453-8866
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX891110OtherNURSING LICENSE
TXAP135362OtherAPRN LICENSE