Provider Demographics
NPI:1700268042
Name:HOUSLEY, SHERRY (APN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:870-867-2175
Mailing Address - Fax:870-867-4050
Practice Address - Street 1:785 W GRANADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5163
Practice Address - Country:US
Practice Address - Phone:386-673-1323
Practice Address - Fax:386-676-7448
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210108758Medicaid