Provider Demographics
NPI:1912305020
Name:SHERRILL, KATIE ANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANNE
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANNE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:8931 LAKE DR APT 501
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-4294
Mailing Address - Country:US
Mailing Address - Phone:321-474-3409
Mailing Address - Fax:
Practice Address - Street 1:8931 LAKE DR APT 501
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-4294
Practice Address - Country:US
Practice Address - Phone:321-474-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9219650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily