Provider Demographics
NPI:1346256286
Name:SHERARD, PATTY L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:L
Last Name:SHERARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1330
Mailing Address - Country:US
Mailing Address - Phone:307-633-4040
Mailing Address - Fax:307-633-4040
Practice Address - Street 1:100 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1330
Practice Address - Country:US
Practice Address - Phone:307-633-4040
Practice Address - Fax:307-633-4040
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY83720085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314334OtherBLUE CROSS
WY104172000Medicaid