Provider Demographics
NPI:1801236815
Name:YOUNG, SHERRY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:110 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEBSTER
Practice Address - State:OH
Practice Address - Zip Code:45682-7502
Practice Address - Country:US
Practice Address - Phone:740-778-1020
Practice Address - Fax:740-778-1022
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18833363L00000X
KY3008103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087454Medicaid
KY7100255210Medicaid