MEDICARE: SHELLIE JEAN PEATON RMA

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1912184532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLIE JEAN PEATON RMA

Provider Business Mailing Address
First Line	:	P. O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-284-1973

Provider Business Practice Location Address
First Line	:	3700 RUFE SNOW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76180-8848
Country	:	US
Telephone Number	:	817-284-1152
Fax Number	:	817-284-1973

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	09/21/2009

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Directions to “ SHELLIE JEAN PEATON RMA” Practice Location

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