Healthcare Provider Details

I. General information

NPI: 1760452734
Provider Name (Legal Business Name): KIMBERLY D SHERRILL F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WOOD ST STE A
MONROE LA
71201-7549
US

IV. Provider business mailing address

711 WOOD ST STE A
MONROE LA
71201-7549
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8847
  • Fax: 318-327-3410
Mailing address:
  • Phone: 318-323-8847
  • Fax: 318-327-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP02829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: