MEDICARE: MS. MELISSA MCINTIRE SHERROD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	239595	TX

General Provider Information

NPI Number	:	1831691260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA MCINTIRE SHERROD APRN

Provider Business Mailing Address
First Line	:	1504 CLOVER LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2427
Country	:	US
Telephone Number	:	817-372-4437
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 VERMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2615
Country	:	US
Telephone Number	:	817-207-0229
Fax Number	:	817-207-0742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/01/2018

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