Provider Demographics
NPI:1831197821
Name:SHEETS, HARRY KYLE (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:KYLE
Last Name:SHEETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 50TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4129
Mailing Address - Country:US
Mailing Address - Phone:888-264-0330
Mailing Address - Fax:806-368-6936
Practice Address - Street 1:610 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3625
Practice Address - Country:US
Practice Address - Phone:806-272-7544
Practice Address - Fax:806-272-5155
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7393207Q00000X, 207P00000X
NM2001-306207Q00000X
KS04-27778207Q00000X
LAMD.207870207Q00000X
OK28260207Q00000X
TNMD0000053504207Q00000X
ALMD.34956207Q00000X
GA75373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB4517Medicaid
TX096857002Medicaid
NM341404205Medicare PIN
NMB4517Medicaid
G81346Medicare UPIN