Provider Demographics
NPI:1578656120
Name:WILLIAMS, SHERRY L (APN)
Entity Type:Individual
Prefix:PROF
First Name:SHERRY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501
Mailing Address - Country:US
Mailing Address - Phone:870-262-1200
Mailing Address - Fax:870-262-6088
Practice Address - Street 1:1710 HARRISON STREET
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:870-262-6088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143595758Medicaid
AR5C216OtherBLUE CROSS/BLUE SHIELD
AR5Y732Medicare ID - Type UnspecifiedMEDICARE
AR5C216OtherBLUE CROSS/BLUE SHIELD