Healthcare Provider Details

I. General information

NPI: 1316585813
Provider Name (Legal Business Name): SHERKEYSHA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHERKEYSHA HENDERSON

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

106 ROSALIE CT
CLINTON MS
39056-6053
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-1775
  • Fax: 614-968-8840
Mailing address:
  • Phone: 601-573-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32711
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903632
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: