Healthcare Provider Details

I. General information

NPI: 1760031330
Provider Name (Legal Business Name): MICAH SHULER PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W LAMBERTH RD STE A
SHERMAN TX
75092-2662
US

IV. Provider business mailing address

6317 CHELSEA WAY
GARLAND TX
75044-3529
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number142963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: