Provider Demographics
NPI:1497799100
Name:WALLING, SHERRI A (NP)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:WALLING
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-476-7200
Mailing Address - Fax:812-471-4514
Practice Address - Street 1:7200 E INDIANA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2753
Practice Address - Country:US
Practice Address - Phone:812-476-7200
Practice Address - Fax:812-471-4514
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001796A363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200503770Medicaid
KY78015849Medicaid
IN000000353774OtherANTHEM PIN
IN247890HMedicare PIN
INQ32541Medicare UPIN
IN145790WMedicare ID - Type Unspecified