Provider Demographics
NPI:1497397277
Name:ATHEARN, SHEILA RAE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:RAE
Last Name:ATHEARN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 THE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-5151
Mailing Address - Country:US
Mailing Address - Phone:254-721-8241
Mailing Address - Fax:
Practice Address - Street 1:900 THE GROVE RD
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-5151
Practice Address - Country:US
Practice Address - Phone:254-721-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09190939OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS