Provider Demographics
NPI:1568543155
Name:STOFER, SHERI L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:L
Last Name:STOFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1287
Mailing Address - Country:US
Mailing Address - Phone:417-926-1770
Mailing Address - Fax:417-926-1785
Practice Address - Street 1:1905 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1287
Practice Address - Country:US
Practice Address - Phone:417-926-1770
Practice Address - Fax:417-926-1785
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004256207RE0101X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D2006074OtherCLIA
MOMA2517OtherMEDICARE (GROUP)
MO1285957001OtherMEDICAID (GROUP)
MO26-8535OtherMEDICARE - RH
MO597780303OtherMEDICAID - RH