Healthcare Provider Details

I. General information

NPI: 1780712174
Provider Name (Legal Business Name): SHERRY A FRANKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 ALDER ST
SOUTH BEND WA
98586-4900
US

IV. Provider business mailing address

PO BOX 269
SOUTH BEND WA
98586-0269
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-5579
  • Fax: 360-875-5235
Mailing address:
  • Phone: 360-875-5579
  • Fax: 360-875-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003371
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: