Healthcare Provider Details

I. General information

NPI: 1710474242
Provider Name (Legal Business Name): SHAYLA R FINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 N ACCESS RD
CLYDE TX
79510-3352
US

IV. Provider business mailing address

235 12TH ST
HAWLEY TX
79525-3127
US

V. Phone/Fax

Practice location:
  • Phone: 325-893-4010
  • Fax: 325-893-4042
Mailing address:
  • Phone: 325-660-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP137333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: