Healthcare Provider Details

I. General information

NPI: 1982105912
Provider Name (Legal Business Name): SHERRY ELAINE HOPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

IV. Provider business mailing address

100 CANARY CIRCLE
CORBIN KY
40701
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-4481
  • Fax:
Mailing address:
  • Phone: 606-280-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012093
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: