MEDICARE: MRS. SHERRY JETTON HOUSTON NP-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	363LF0000X	Family Nurse Practitioner	579467	TX

General Provider Information

NPI Number	:	1669586194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRY JETTON HOUSTON NP-C

Provider Business Mailing Address
First Line	:	2410 FREEDOM LN
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-3701
Country	:	US
Telephone Number	:	254-547-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 E STAN SCHLUETER LOOP
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-8352
Country	:	US
Telephone Number	:	254-690-2800
Fax Number	:	254-690-5401

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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