Healthcare Provider Details

I. General information

NPI: 1225143563
Provider Name (Legal Business Name): SHERRY CAUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N. KEMPER STREET
LAKE VIEW SC
29563
US

IV. Provider business mailing address

103 N. KEMPER STREET
LAKE VIEW SC
29563
US

V. Phone/Fax

Practice location:
  • Phone: 843-759-2189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN1803
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: