Provider Demographics
NPI:1669422986
Name:SHERRY, BARBARA J (PAC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:SHERRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DENNIS ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5459
Mailing Address - Country:US
Mailing Address - Phone:360-754-6367
Mailing Address - Fax:
Practice Address - Street 1:150 DENNIS ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5459
Practice Address - Country:US
Practice Address - Phone:360-754-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA190051OtherLABOR & INDUSTRIES
WA1025519Medicaid
Q27294Medicare UPIN
WA1025519Medicaid