Provider Demographics
NPI:1598805046
Name:GLOVER, SHERRY L (NP)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:GLOVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:R
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 DAYTON BLVD STE 2109
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-4629
Mailing Address - Country:US
Mailing Address - Phone:423-362-8400
Mailing Address - Fax:423-362-8399
Practice Address - Street 1:3500 DAYTON BLVD STE 2109
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-4629
Practice Address - Country:US
Practice Address - Phone:423-362-8400
Practice Address - Fax:423-362-8399
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65995163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I0554606Medicare PIN