Healthcare Provider Details

I. General information

NPI: 1669552642
Provider Name (Legal Business Name): SHERRY D. CALLAHAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 ALCORN DR
CORINTH MS
38834-9392
US

IV. Provider business mailing address

PO BOX 298
FLORENCE AL
35631-0298
US

V. Phone/Fax

Practice location:
  • Phone: 662-396-4733
  • Fax: 662-396-4735
Mailing address:
  • Phone: 256-767-7494
  • Fax: 256-760-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA810104
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: