Provider Demographics
NPI:1457538431
Name:GORE, SHERYL KIMBERLY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:KIMBERLY
Last Name:GORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SHERYL
Other - Middle Name:RANSOM
Other - Last Name:KINDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:648 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4766
Mailing Address - Country:US
Mailing Address - Phone:318-738-6101
Mailing Address - Fax:
Practice Address - Street 1:10524 E HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8371
Practice Address - Country:US
Practice Address - Phone:520-366-0300
Practice Address - Fax:520-366-0400
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA081278-05327363LF0000X
AZ305422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035009Medicaid