Provider Demographics
NPI:1760966824
Name:CHURCH, SIERRA (PA-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:120 PROFESSIONAL PARK DR SE STE 7
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6739
Mailing Address - Country:US
Mailing Address - Phone:540-443-3832
Mailing Address - Fax:540-443-9362
Practice Address - Street 1:120 PROFESSIONAL PARK DR SE STE 7
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6739
Practice Address - Country:US
Practice Address - Phone:540-443-3832
Practice Address - Fax:540-443-9362
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006397363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical