Provider Demographics
NPI:1144805862
Name:MILLER, SHERRY
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:MIDKIFF
Mailing Address - State:WV
Mailing Address - Zip Code:25540-0253
Mailing Address - Country:US
Mailing Address - Phone:304-690-4809
Mailing Address - Fax:
Practice Address - Street 1:9559 STOUT CK
Practice Address - Street 2:
Practice Address - City:MIDKIFF
Practice Address - State:WV
Practice Address - Zip Code:25540
Practice Address - Country:US
Practice Address - Phone:304-690-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker