Provider Demographics
NPI:1679394951
Name:SHERRELL, KHRISTY JENEEN (FNP)
Entity type:Individual
Prefix:
First Name:KHRISTY
Middle Name:JENEEN
Last Name:SHERRELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KHRISTY
Other - Middle Name:JENEEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2611 SHALE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2242
Mailing Address - Country:US
Mailing Address - Phone:972-217-6758
Mailing Address - Fax:
Practice Address - Street 1:2611 SHALE ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2242
Practice Address - Country:US
Practice Address - Phone:972-217-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine