Provider Demographics
NPI:1952004178
Name:SHEDD, MISTY LYN (NP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LYN
Last Name:SHEDD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 SPRINGHILL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2781
Mailing Address - Country:US
Mailing Address - Phone:214-551-2287
Mailing Address - Fax:
Practice Address - Street 1:941 W BETHANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3739
Practice Address - Country:US
Practice Address - Phone:972-908-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113636363L00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology