Provider Demographics
NPI:1073927471
Name:BENNER, SHERRY ALENE (APRN, CNM)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ALENE
Last Name:BENNER
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:279 KINGS DAUGHTERS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6561
Practice Address - Country:US
Practice Address - Phone:502-227-2229
Practice Address - Fax:502-227-1114
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCNM1776367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9159304663Medicaid