Healthcare Provider Details

I. General information

NPI: 1508783242
Provider Name (Legal Business Name): CHYNNA SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 ALDERSON ST FL 3
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

399 KANADA ST
LOGAN WV
25601-3706
US

V. Phone/Fax

Practice location:
  • Phone: 866-860-9772
  • Fax:
Mailing address:
  • Phone: 304-601-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number108795
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: