Provider Demographics
NPI:1144662354
Name:MONTELLANO, SHERRIE KAY (PA-C)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:KAY
Last Name:MONTELLANO
Suffix:
Gender:F
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 1:3 E APPLEBY RD STE 402
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3163
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:479-404-1251
Practice Address - Street 1:3 E APPLEBY RD STE 402
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3163
Practice Address - Country:US
Practice Address - Phone:479-404-1250
Practice Address - Fax:479-404-1251
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-1317363AM0700X
COPA.0003741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-1317OtherARKANSAS STATE MEDICAL BOARD