Provider Demographics
NPI:1740235811
Name:SHIRLEY - JONES, SHERRY G (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:G
Last Name:SHIRLEY - JONES
Suffix:
Gender:
Credentials:MD
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 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:612 STOCKTON STREET
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129
Practice Address - Country:US
Practice Address - Phone:270-432-4320
Practice Address - Fax:270-432-3662
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64072523Medicaid
KY000000628888OtherANTHEM BCBS
KYK002991Medicare PIN
KY000000628888OtherANTHEM BCBS
KY7100017280Medicaid