Basic Information
| Provider Information | |||||||||
| NPI: | 1497703219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPEARS-SHEA | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 CAGLE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551940 | ||||||||
| FaxNumber: | 8172551977 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CAGLE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551940 | ||||||||
| FaxNumber: | 8172551977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 01/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 583275 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 189628401 | 05 | TX | MEDICAID | 041592904 | 05 | TX | MEDICAID | 041592910 | 05 | TX | MEDICAID | 041592902 | 05 | TX | MEDICAID | 041592909 | 05 | TX | MEDICAID | 041592903 | 05 | TX | MEDICAID | 041592908 | 05 | TX | MEDICAID |