Provider Demographics
NPI:1225143563
Name:CAUSEY, SHERRY
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:CAUSEY
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 1:103 N. KEMPER STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 N. KEMPER STREET
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:SC
Practice Address - Zip Code:29563
Practice Address - Country:US
Practice Address - Phone:843-759-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1746Medicaid
SCP00284620OtherRAILROAD MEDICARE PTAN
SCNP1746Medicaid
SCP00284620OtherRAILROAD MEDICARE PTAN
SCSC55881850Medicare PIN