MEDICARE: DR. SIDNEY STEWART FERNALD RN, APN, NP-C, D.C.

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	111N00000X	Chiropractor	DC6861	TX
2	363LF0000X	Family Nurse Practitioner	790354	TX
3	363LF0000X	Family Nurse Practitioner	AP-121523	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC6861	OTHER	TX	LICENCE NUMBER
2	742920952	OTHER	TX	TAX IDENTIFICATION
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8A1120	OTHER	TX	BCBS PROVIDER

General Provider Information

NPI Number	:	1396824413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDNEY STEWART FERNALD RN, APN, NP-C, D.C.

Provider Business Mailing Address
First Line	:	1800 S MAIN ST
Second Line	:	SUITE 450
City	:	MCALLEN
State	:	TX
Zip	:	78503-5441
Country	:	US
Telephone Number	:	956-631-0142
Fax Number	:	956-618-0446

Provider Business Practice Location Address
First Line	:	2311 MONACO DR
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-8471
Country	:	US
Telephone Number	:	956-821-6163
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/25/2021

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