Provider Demographics
NPI:1265446199
Name:LOCEY, SHERRY CHARLETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:CHARLETTE
Last Name:LOCEY
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 1:1209 WEST ROBINSON
Mailing Address - Street 2:
Mailing Address - City:WAYNE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62895
Mailing Address - Country:US
Mailing Address - Phone:618-895-2050
Mailing Address - Fax:618-895-2056
Practice Address - Street 1:1209 WEST ROBINSON
Practice Address - Street 2:
Practice Address - City:WAYNE CITY
Practice Address - State:IL
Practice Address - Zip Code:62895
Practice Address - Country:US
Practice Address - Phone:618-895-2050
Practice Address - Fax:618-895-2056
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0085001020363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
704010Medicare ID - Type Unspecified
ILK39344Medicare PIN
S78975Medicare UPIN