Provider Demographics
NPI:1619793684
Name:GREGORY, SHEILA RENEE (NP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENEE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TWIN PEAKS TRL
Mailing Address - Street 2:
Mailing Address - City:BIGELOW
Mailing Address - State:AR
Mailing Address - Zip Code:72016-9661
Mailing Address - Country:US
Mailing Address - Phone:650-798-4277
Mailing Address - Fax:
Practice Address - Street 1:91 TWIN PEAKS TRL
Practice Address - Street 2:
Practice Address - City:BIGELOW
Practice Address - State:AR
Practice Address - Zip Code:72016-9661
Practice Address - Country:US
Practice Address - Phone:650-798-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227221363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care