Healthcare Provider Details

I. General information

NPI: 1639267990
Provider Name (Legal Business Name): SHERRI LYNN MCDONALD APRN,BC,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST
CHARLESTON MO
63834-1644
US

IV. Provider business mailing address

4287 COUNTY ROAD 634
CAPE GIRARDEAU MO
63701-8824
US

V. Phone/Fax

Practice location:
  • Phone: 573-683-3739
  • Fax:
Mailing address:
  • Phone: 573-334-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number124558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: