Provider Demographics
NPI:1669641874
Name:CLEM, SHERYL GUFFIN (CRNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:GUFFIN
Last Name:CLEM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 WHITESBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1632
Mailing Address - Country:US
Mailing Address - Phone:256-327-5800
Mailing Address - Fax:256-327-5977
Practice Address - Street 1:4715 WHITESBURG DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1632
Practice Address - Country:US
Practice Address - Phone:256-881-5151
Practice Address - Fax:256-880-3939
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-099778OtherLICENSE
AL134709Medicaid