Healthcare Provider Details

I. General information

NPI: 1972786226
Provider Name (Legal Business Name): SHERRIE DEE ALICIE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 24
POPLAR BRANCH NC
27965-0024
US

IV. Provider business mailing address

160 EDGEWATER DR
GRANDY NC
27939-9628
US

V. Phone/Fax

Practice location:
  • Phone: 252-900-4332
  • Fax:
Mailing address:
  • Phone: 540-729-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020682
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: