Provider Demographics
NPI:1215154398
Name:WYMAN, SHEILA LOUISE (FNP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:LOUISE
Last Name:WYMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-1239
Mailing Address - Country:US
Mailing Address - Phone:417-546-2590
Mailing Address - Fax:417-546-2590
Practice Address - Street 1:10726 STATE HIGHWAY 76
Practice Address - Street 2:STE G
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653-5450
Practice Address - Country:US
Practice Address - Phone:417-546-2590
Practice Address - Fax:417-546-2594
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP46251Medicare UPIN