Provider Demographics
NPI:1295804862
Name:SHERRILL, DIANNE KIRSTEN (PAC)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:KIRSTEN
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:DIANNE
Other - Middle Name:KIRSTEN
Other - Last Name:WEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-618-8039
Mailing Address - Fax:254-618-8099
Practice Address - Street 1:BATALLION AVENUE AND 761ST TANK BATALLION
Practice Address - Street 2:BLDG 420 BENNETT HEALTH CLINIC
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-618-8039
Practice Address - Fax:254-618-8099
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant