Provider Demographics
NPI:1578004529
Name:GALLIMORE, SHERRY (NP-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:GALLIMORE
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 1:9730 HIGHWAY 641 N
Mailing Address - Street 2:
Mailing Address - City:PURYEAR
Mailing Address - State:TN
Mailing Address - Zip Code:38251-6423
Mailing Address - Country:US
Mailing Address - Phone:731-247-5262
Mailing Address - Fax:
Practice Address - Street 1:9730 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:PURYEAR
Practice Address - State:TN
Practice Address - Zip Code:38251-6423
Practice Address - Country:US
Practice Address - Phone:731-247-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily