Healthcare Provider Details

I. General information

NPI: 1790191757
Provider Name (Legal Business Name): SHERRELL M OGLETREE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 RAYFORD RD SUITE 100
SPRING TX
77386-4364
US

IV. Provider business mailing address

3515 RAYFORD RD SUITE 100
SPRING TX
77386-4364
US

V. Phone/Fax

Practice location:
  • Phone: 281-350-7040
  • Fax:
Mailing address:
  • Phone: 281-350-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP124530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: