Provider Demographics
NPI:1518371228
Name:BONE, SHERRY (LPP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:BONE
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 STATE ROUTE 307
Mailing Address - Street 2:
Mailing Address - City:CUNNINGHAM
Mailing Address - State:KY
Mailing Address - Zip Code:42035-9436
Mailing Address - Country:US
Mailing Address - Phone:270-642-2659
Mailing Address - Fax:270-642-2649
Practice Address - Street 1:4630 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7502
Practice Address - Country:US
Practice Address - Phone:270-642-2659
Practice Address - Fax:270-642-2649
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical