Provider Demographics
NPI:1831399955
Name:SISK, SHEILA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MICHELLE
Last Name:SISK
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: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:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:478 WHIRLAWAY DRIVE STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9037
Practice Address - Country:US
Practice Address - Phone:859-236-4333
Practice Address - Fax:859-236-2284
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005229363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100024500Medicaid
11743206OtherCAQH
KY2007004387OtherBOARD CERTIFICATION
KY3005229OtherKENTUCKY BOARD OF NURSING APRN LICENSE