Provider Demographics
NPI:1295363810
Name:KERSHNER, SHERIE JOAN
Entity Type:Individual
Prefix:
First Name:SHERIE
Middle Name:JOAN
Last Name:KERSHNER
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 1:324 STAYMAN DR
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-4235
Mailing Address - Country:US
Mailing Address - Phone:304-433-7589
Mailing Address - Fax:
Practice Address - Street 1:324 STAYMAN DR
Practice Address - Street 2:
Practice Address - City:FALLING WATERS
Practice Address - State:WV
Practice Address - Zip Code:25419-4235
Practice Address - Country:US
Practice Address - Phone:304-433-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily