Individual
SHELAGH BROWN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
855 MONTGOMERY ST, DEPT OF OB/GYN, FORT WORTH, TX 76107-2553
(817) 927-1065
(817) 927-1162
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 927-1065
(817) 927-1162
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
537106
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185877101
—
TX
01
—
8Y1549
BCBS
TX
01
—
P01110876
RAILROAD MEDICARE
TX
Enumeration date
02/07/2007
Last updated
02/07/2013
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