Provider Demographics
NPI:1497331854
Name:STILTNER, SHERRY RENEE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:RENEE
Last Name:STILTNER
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 1:2719 DARK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9397
Mailing Address - Country:US
Mailing Address - Phone:740-418-1582
Mailing Address - Fax:
Practice Address - Street 1:9001 STATE ROUTE 139
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9274
Practice Address - Country:US
Practice Address - Phone:740-286-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH552760Medicaid