Provider Demographics
NPI:1629408497
Name:BENNETT, SHERILYN JO (APRN)
Entity Type:Individual
Prefix:
First Name:SHERILYN
Middle Name:JO
Last Name:BENNETT
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 1:1683 JENKINS RD
Mailing Address - Street 2:PO BOX 2031
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-8061
Mailing Address - Country:US
Mailing Address - Phone:479-637-1181
Mailing Address - Fax:
Practice Address - Street 1:1341 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-7642
Practice Address - Country:US
Practice Address - Phone:479-637-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR86370163W00000X
ARA003998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse