Provider Demographics
NPI:1669743662
Name:SHERRILL, PAMELA BETH (MED)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:BETH
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-4279
Mailing Address - Country:US
Mailing Address - Phone:186-692-6655
Mailing Address - Fax:580-480-1212
Practice Address - Street 1:125 N OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4279
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:580-480-1212
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor