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General NPI Number Information
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NPI Number | 1063113033
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Entity Type | Individual
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Provider Name | KELLY S. SHERRILL CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1118 ROSS CLARK CIR STE 100
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City | DOTHAN
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State | AL
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Zip | 36301-3023
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Country | US
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Telephone | 334-794-1148
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Fax |
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Provider Business Mailing Address
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Address Line | 797 STRICKLAND RD
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City | HEADLAND
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State | AL
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Zip | 36345-8440
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Country | US
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Telephone | 334-618-6565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG02230064
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License Number State | AL
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