Provider Demographics
NPI:1609235878
Name:MCINTOSH, SHERRY G (APRN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:G
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SMOKEY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2508
Mailing Address - Country:US
Mailing Address - Phone:501-771-2799
Mailing Address - Fax:501-758-6215
Practice Address - Street 1:308 SMOKEY LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2508
Practice Address - Country:US
Practice Address - Phone:501-771-2799
Practice Address - Fax:501-758-6215
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004666363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR212623758Medicaid