Provider Demographics
NPI:1720266851
Name:RUDNICK, SHERRY R (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:R
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MOHAWKS ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210
Mailing Address - Country:US
Mailing Address - Phone:270-597-2155
Mailing Address - Fax:270-597-3811
Practice Address - Street 1:104 MOHAWKS ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210
Practice Address - Country:US
Practice Address - Phone:270-597-2155
Practice Address - Fax:270-597-3811
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100040950Medicaid
KY11806524OtherCAQH