Provider Demographics
NPI:1609198753
Name:JOBE, SHERRY BULLARD (RN, MSN, ACNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:BULLARD
Last Name:JOBE
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-C
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:BULLARD
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, ACNP-BC
Mailing Address - Street 1:100 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9372
Mailing Address - Country:US
Mailing Address - Phone:662-284-8566
Mailing Address - Fax:662-594-8366
Practice Address - Street 1:2668 S HARPER RD STE 1
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6770
Practice Address - Country:US
Practice Address - Phone:662-287-7138
Practice Address - Fax:662-287-7157
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR701122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1609198753Medicaid
MS1609198753Medicaid