MEDICARE: JAMIE RENEE SHIELDS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	AP135034	TX

General Provider Information

NPI Number	:	1316457278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE RENEE SHIELDS NP

Provider Business Mailing Address
First Line	:	10220 RED BLUFF LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 EPHRIHAM AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-6642
Country	:	US
Telephone Number	:	817-702-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	10/05/2017

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