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Individual
DR. SIDNEY STEWART FERNALD
Active
Individual
DR. SIDNEY STEWART FERNALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, APN, NP-C, D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC6861
TX
363LF0000X
Family Nurse Practitioner
790354
TX
363LF0000X
Family Nurse Practitioner
Primary
AP-121523
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002110701
—
TX
01
—
742920952
TAX IDENTIFICATION
TX
01
—
8A1120
BCBS PROVIDER
TX
01
—
DC6861
LICENCE NUMBER
TX
Enumeration date
11/02/2006
Last updated
08/25/2021
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