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General NPI Number Information
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NPI Number | 1750564761
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Entity Type | Individual
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Provider Name | TEDDI STEPHANIE SHEAROUSE RN, CNS, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2115 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-4407
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Country | US
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Telephone | 903-887-4788
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Fax | 903-340-8527
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Provider Business Mailing Address
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Address Line | 2115 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-4407
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Country | US
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Telephone | 903-887-4788
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Fax | 903-340-8527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 654758
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 654758
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 654758
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License Number State | TX
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