Provider Demographics
NPI:1972827681
Name:SHERLING, KELLEY WILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:WILLIS
Last Name:SHERLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1520
Mailing Address - Country:US
Mailing Address - Phone:504-349-6423
Mailing Address - Fax:504-934-8097
Practice Address - Street 1:1111 MEDICAL CENTER BLVD.
Practice Address - Street 2:SUTIE S-450
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6401
Practice Address - Fax:504-349-6444
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206813207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107607Medicaid
LA350228Medicare PIN