Healthcare Provider Details

I. General information

NPI: 1831691260
Provider Name (Legal Business Name): MELISSA MCINTIRE SHERROD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 VERMONT AVE
FORT WORTH TX
76115-2615
US

IV. Provider business mailing address

1504 CLOVER LN
FORT WORTH TX
76107-2427
US

V. Phone/Fax

Practice location:
  • Phone: 817-207-0229
  • Fax: 817-207-0742
Mailing address:
  • Phone: 817-372-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number239595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: