Provider Demographics
NPI:1881613016
Name:SMILEY, SHERRY SUE (ARNP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:SUE
Last Name:SMILEY
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 1:420 W 15TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5367
Mailing Address - Country:US
Mailing Address - Phone:620-343-2376
Mailing Address - Fax:620-343-0095
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2587
Practice Address - Country:US
Practice Address - Phone:620-343-2376
Practice Address - Fax:620-343-0095
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100388960BMedicaid
KSP00057490OtherMEDICARE RAILROAD
KS161060OtherBC/BS
KSP28718Medicare UPIN
KSP00057490OtherMEDICARE RAILROAD