Provider Demographics
NPI:1639942790
Name:BASS, SHERRY ANN
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:BASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:BORGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0255
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:
Practice Address - Street 1:695 MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-0255
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant