Healthcare Provider Details

I. General information

NPI: 1023193364
Provider Name (Legal Business Name): SHERRY A AUCOIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY GREGORY

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 HIGHWAY 18
EDGARD LA
70049-2417
US

IV. Provider business mailing address

PO BOX 1319
LORTON VA
22199-1319
US

V. Phone/Fax

Practice location:
  • Phone: 985-267-1093
  • Fax:
Mailing address:
  • Phone: 727-452-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171174
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1031429
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05043
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: