Provider Demographics
NPI:1992572317
Name:LOPEZ, SHEY LYNN (AGACNP)
Entity type:Individual
Prefix:
First Name:SHEY
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2520
Mailing Address - Country:US
Mailing Address - Phone:830-613-2038
Mailing Address - Fax:
Practice Address - Street 1:910 POWDERHORN DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2520
Practice Address - Country:US
Practice Address - Phone:830-613-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141572363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology