Provider Demographics
NPI:1568281046
Name:SHERROUSE, CLINT STEWART (FNP)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:STEWART
Last Name:SHERROUSE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 WALLACESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7498
Mailing Address - Country:US
Mailing Address - Phone:281-415-9926
Mailing Address - Fax:
Practice Address - Street 1:1105 UNIVERSITY DR E STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2183
Practice Address - Country:US
Practice Address - Phone:281-415-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily