Provider Demographics
NPI:1295398402
Name:FAULKINER, SHERRI SUE
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:SUE
Last Name:FAULKINER
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 1:176 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1064
Mailing Address - Country:US
Mailing Address - Phone:304-438-6186
Mailing Address - Fax:681-318-3613
Practice Address - Street 1:176 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1064
Practice Address - Country:US
Practice Address - Phone:304-438-6186
Practice Address - Fax:304-799-6636
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily