Provider Demographics
NPI:1497208185
Name:SHERRILL, KRYSTAL (FNP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:5520 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4220
Practice Address - Country:US
Practice Address - Phone:806-761-0475
Practice Address - Fax:806-793-0693
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily