Provider Demographics
NPI:1164403150
Name:HUGHES, SHERRY ANN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ANN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:110 COUNTRY VILLA LN APT 2A
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-9501
Mailing Address - Country:US
Mailing Address - Phone:254-319-2169
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1049269363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1049269OtherNCCPA LICENSE