Provider Demographics
NPI:1407449069
Name:SHERARD, JERITA SARANA (NP)
Entity Type:Individual
Prefix:
First Name:JERITA
Middle Name:SARANA
Last Name:SHERARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 AGNEW RD
Mailing Address - Street 2:
Mailing Address - City:STARR
Mailing Address - State:SC
Mailing Address - Zip Code:29684-9055
Mailing Address - Country:US
Mailing Address - Phone:864-276-2890
Mailing Address - Fax:
Practice Address - Street 1:3322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4108
Practice Address - Country:US
Practice Address - Phone:864-715-3309
Practice Address - Fax:864-715-3312
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily