Provider Demographics
NPI:1790894335
Name:ROBERTSON, SHERRI A (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-705-2896
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:4209 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3065
Practice Address - Country:US
Practice Address - Phone:601-705-2896
Practice Address - Fax:601-264-0732
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR739582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118300Medicaid
MS640507572YWOtherAMERICAN ADMIN GROUP
S40062Medicare UPIN
MS00118300Medicaid