Provider Demographics
NPI:1003876897
Name:PERSINGER, SHERRY LYNN (PA)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
Last Name:PERSINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1003 OAKHURST DRVIE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314
Mailing Address - Country:US
Mailing Address - Phone:304-345-4525
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:1003 OAKHURST DR.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314
Practice Address - Country:US
Practice Address - Phone:304-345-4525
Practice Address - Fax:304-345-4527
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P08372Medicare UPIN
WVPE6035561Medicare PIN
WVP00405524Medicare PIN