MEDICARE: KAYLA SHERMAN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704306835	MI

General Provider Information

NPI Number	:	1063169480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SHERMAN FNP-C

Provider Business Mailing Address
First Line	:	571 NANCY LN
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-9521
Country	:	US
Telephone Number	:	989-350-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	994 N CENTER AVE
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-9356
Country	:	US
Telephone Number	:	989-732-3450
Fax Number	:	989-731-4513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2022
Last Update Date	:	03/05/2022

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