Provider Demographics
NPI:1063828291
Name:FENWICK, STERLING T (PA-C)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:T
Last Name:FENWICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-578-2180
Mailing Address - Fax:307-578-2181
Practice Address - Street 1:720 LINDSAY LN STE C
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4143
Practice Address - Country:US
Practice Address - Phone:307-578-2180
Practice Address - Fax:307-578-2181
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2018-0013363AM0700X
UT7817012-1206363AM0700X
WYPA600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical