Provider Demographics
NPI:1083860480
Name:WALL, SHERRY LEIGH (MSN RN-ANP-C)
Entity Type:Individual
Prefix:MR
First Name:SHERRY
Middle Name:LEIGH
Last Name:WALL
Suffix:
Gender:F
Credentials:MSN RN-ANP-C
Other - Prefix:MISS
Other - First Name:SHERRY
Other - Middle Name:LEIGH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 N MCKINNEY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480
Mailing Address - Country:US
Mailing Address - Phone:979-205-9028
Mailing Address - Fax:979-548-2508
Practice Address - Street 1:303 N MCKINNEY
Practice Address - Street 2:SUITE C
Practice Address - City:SUEENY
Practice Address - State:TX
Practice Address - Zip Code:77480
Practice Address - Country:US
Practice Address - Phone:979-205-9028
Practice Address - Fax:979-548-2508
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641733363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner