Provider Demographics
NPI:1942302534
Name:PERGREM, SHERRI S
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:S
Last Name:PERGREM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 PEELED OAK RD
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-8316
Mailing Address - Country:US
Mailing Address - Phone:606-674-3904
Mailing Address - Fax:
Practice Address - Street 1:1787 PEELED OAK RD
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8316
Practice Address - Country:US
Practice Address - Phone:606-674-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist