Provider Demographics
NPI:1154968279
Name:SLACK, SHEREE LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:LYNN
Last Name:SLACK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 SCARLET POND LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2524
Mailing Address - Country:US
Mailing Address - Phone:313-283-2118
Mailing Address - Fax:
Practice Address - Street 1:8588 KATY FWY STE 226A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1881
Practice Address - Country:US
Practice Address - Phone:713-532-6884
Practice Address - Fax:713-532-5756
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPRNCNP1018576363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology