Provider Demographics
NPI:1013089226
Name:CAULEY, SHERRY LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:CAULEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX Q
Mailing Address - Street 2:1025 WEST MAIN STREET
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0397
Mailing Address - Country:US
Mailing Address - Phone:573-431-1947
Mailing Address - Fax:573-431-7326
Practice Address - Street 1:1025 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2079
Practice Address - Country:US
Practice Address - Phone:573-431-1947
Practice Address - Fax:573-431-7326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003042124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9181347Medicaid