Provider Demographics
NPI:1336167352
Name:SUMMITT, SHERRY A (R, MR)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:SUMMITT
Suffix:
Gender:F
Credentials:R, MR
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9630
Mailing Address - Country:US
Mailing Address - Phone:501-679-0511
Mailing Address - Fax:
Practice Address - Street 1:2585 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2327
Practice Address - Country:US
Practice Address - Phone:501-764-1201
Practice Address - Fax:501-764-1204
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RTL000699247100000X
1911232471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging