Provider Demographics
NPI:1083685416
Name:SHERRELL, FERN (APN)
Entity Type:Individual
Prefix:
First Name:FERN
Middle Name:
Last Name:SHERRELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1130
Mailing Address - Street 2:1019 EAST MAIN
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556
Mailing Address - Country:US
Mailing Address - Phone:870-368-4729
Mailing Address - Fax:870-368-4487
Practice Address - Street 1:1019 EAST MAIN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556
Practice Address - Country:US
Practice Address - Phone:870-368-4729
Practice Address - Fax:870-368-4729
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01845 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158109758Medicaid
AR158109758Medicaid
ARQ48980Medicare UPIN