MEDICARE: SHERYL LYNN MIMS REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	680044	TX

General Provider Information

NPI Number	:	1972084556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL LYNN MIMS REGISTERED NURSE

Provider Business Mailing Address
First Line	:	5200 TWO STEP PL
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-4070
Country	:	US
Telephone Number	:	254-371-6419
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 ELM ST APT 16
Second Line	:
City	:	EVANT
State	:	TX
Zip	:	76525-9655
Country	:	US
Telephone Number	:	254-371-6419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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