Provider Demographics
NPI:1629030200
Name:PEVETO, SHERRY S (WHNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:S
Last Name:PEVETO
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:S
Other - Last Name:WYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-388-4030
Mailing Address - Fax:318-998-3999
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-388-4030
Practice Address - Fax:318-998-3999
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN080786363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559911Medicaid
LA4B381C148Medicare PIN
LAP02832Medicare UPIN