Provider Demographics
NPI:1942357298
Name:SHERRILL, LISA RENEE (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 NORTHTOWN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3105
Mailing Address - Country:US
Mailing Address - Phone:870-425-3131
Mailing Address - Fax:870-425-3136
Practice Address - Street 1:614 NORTHTOWN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3105
Practice Address - Country:US
Practice Address - Phone:870-425-3131
Practice Address - Fax:870-425-3136
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A227Medicare PIN