Healthcare Provider Details

I. General information

NPI: 1457013567
Provider Name (Legal Business Name): KAMISHA SHENAY BYRD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 05/25/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 IH-10 FRONTAGE RD
BEAUMONT TX
77702
US

IV. Provider business mailing address

12377 MERIT DR STE 300
DALLAS TX
75251-3126
US

V. Phone/Fax

Practice location:
  • Phone: 409-212-9988
  • Fax: 409-212-8449
Mailing address:
  • Phone: 972-957-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1057170
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1057179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: