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General NPI Number Information
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NPI Number | 1154696169
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Entity Type | Organization
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Legal Business Name | GREEN ISLAND HEALTH PLLC
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 6450 SUMAC RD
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City | FORT WORTH
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State | TX
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Zip | 76116-8131
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Country | US
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Telephone | 214-557-8061
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Fax | 817-732-4939
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Provider Business Mailing Address
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Address Line | 6450 SUMAC RD
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City | FORT WORTH
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State | TX
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Zip | 76116-8131
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Country | US
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Telephone | 214-557-8061
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Fax | 817-732-4939
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Authorized Official
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Title or Position | PHYSICIAN MEMBER
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Name | DR. HEATHER P SHELTON
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Credential | MD
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Telephone | 214-557-8061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L5904
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License Number State | TX
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