Healthcare Provider Details

I. General information

NPI: 1962983338
Provider Name (Legal Business Name): SHERRILL KAY HINDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 N STATE RD
GRAYVILLE IL
62844-1266
US

IV. Provider business mailing address

48 N STATE RD
GRAYVILLE IL
62844-1266
US

V. Phone/Fax

Practice location:
  • Phone: 618-384-1111
  • Fax:
Mailing address:
  • Phone: 618-384-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: