Provider Demographics
NPI:1104337518
Name:DWYER, SHEILA KATHLEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:KATHLEEN
Last Name:DWYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11797 SOUTH FWY
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7026
Mailing Address - Country:US
Mailing Address - Phone:817-293-2944
Mailing Address - Fax:817-293-2039
Practice Address - Street 1:11797 SOUTH FWY STE 234
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-293-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8HV901OtherBLUE CROSS BLUE SHIELD
TX378324301Medicaid
TX617414YM36OtherMEDICARE