Provider Demographics
NPI:1518073907
Name:DUVALL, SHERRY L (C-FNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:DUVALL
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MEDICAL PLACE
Mailing Address - Street 2:AIRPORT INDUSTRIAL PARK, COMMERCE DRIVE
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813
Mailing Address - Country:US
Mailing Address - Phone:304-255-1080
Mailing Address - Fax:304-255-1082
Practice Address - Street 1:134 MEDICAL PLACE
Practice Address - Street 2:AIRPORT INDUSTRIAL PARK, COMMERCE DRIVE
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-1080
Practice Address - Fax:304-255-1082
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7104149000Medicaid
WVP78237Medicare UPIN
WV7104149000Medicaid