Provider Demographics
NPI:1477526572
Name:NEWSOME, SHERRY C (CRNA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:C
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:SHALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:52 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 321
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3055
Mailing Address - Fax:205-838-3517
Practice Address - Street 1:52 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 321
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-838-3055
Practice Address - Fax:205-838-3517
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1019466367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000071365Medicaid
ALR69082Medicare UPIN
AL000071365Medicare ID - Type Unspecified