Provider Demographics
NPI:1558823161
Name:JOHNSON, SHERRY LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 BEES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-6840
Mailing Address - Country:US
Mailing Address - Phone:843-441-6579
Mailing Address - Fax:
Practice Address - Street 1:915 VINTAGE VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9800
Practice Address - Country:US
Practice Address - Phone:509-314-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60945506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily