Provider Demographics
NPI:1669586194
Name:HOUSTON, SHERRY JETTON (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:JETTON
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3701
Mailing Address - Country:US
Mailing Address - Phone:254-547-3915
Mailing Address - Fax:
Practice Address - Street 1:4204 E STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-8352
Practice Address - Country:US
Practice Address - Phone:254-690-2800
Practice Address - Fax:254-690-5401
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX579467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
8D9632Medicare ID - Type Unspecified
TXQ51704Medicare UPIN