Provider Demographics
NPI:1063975621
Name:FREDERICK, SHEILA ANN (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ANN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PATTON CEMETARY RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-9353
Mailing Address - Country:US
Mailing Address - Phone:662-213-8086
Mailing Address - Fax:
Practice Address - Street 1:65 PATTON CEMETARY RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-9353
Practice Address - Country:US
Practice Address - Phone:662-213-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903158363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology