Provider Demographics
NPI:1215468129
Name:SHIRLEY, ANNALA J (NP-C)
Entity type:Individual
Prefix:
First Name:ANNALA
Middle Name:J
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 731912
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1912
Mailing Address - Country:US
Mailing Address - Phone:903-877-7635
Mailing Address - Fax:903-877-7754
Practice Address - Street 1:721 CLINIC DR
Practice Address - Street 2:STE A
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2043
Practice Address - Country:US
Practice Address - Phone:903-595-7014
Practice Address - Fax:903-526-0629
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP133662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner