Individual
SHELIA E CHEATHAM-MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 335-3022
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP117713
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206081602
—
TX
01
—
206081603
MEDICAID CSHCN
TX
01
—
8766NK
BLUE CROSS/BLUE SHIELD
—
Enumeration date
05/18/2009
Last updated
03/06/2020
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