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General NPI Number Information
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NPI Number | 1194919274
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Entity Type | Individual
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Provider Name | MATTIE YULONDA SHERARD NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 6231 PERIMETER DR STE 113
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3658
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Country | US
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Telephone | 423-475-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 MILLBROOK DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35810-3235
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Country | US
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Telephone | 423-400-3056
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000012272
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License Number State | TN
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