=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942686241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRY NELSON ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2015
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2825 E BARNETT RD
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-8332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-789-7000
-----------------------------------------------------
Fax | 541-789-7111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 MEDICAL CENTER DR STE 200
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-930-7222
-----------------------------------------------------
Fax | 541-930-7220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 201805234NP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------