Provider Demographics
NPI:1740513308
Name:SMITH, SHERRY DAUGHETY (NP)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:DAUGHETY
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LANG
Other - Last Name:DAUGHETY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:252-559-2200
Mailing Address - Fax:252-522-9778
Practice Address - Street 1:313 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8209
Practice Address - Country:US
Practice Address - Phone:252-559-2200
Practice Address - Fax:252-522-9778
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908296OtherGROUP MEDICAID
NC1467405431OtherGROUP NPI
NC7000725Medicaid
NC0326OtherGROUP PTAN
NC89019860OtherGROUP MEDICAID
NC2594651Medicare PIN