=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538617741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRY MAYES CLOUNCH AGACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2016
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 W MARKET ST STE B
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35611-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-787-2924
-----------------------------------------------------
Fax | 256-408-9971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 W MARKET ST STE B
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35611-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-787-2924
-----------------------------------------------------
Fax | 256-408-9971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1-109165
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------