1710165220 NPI number — DR. SHERYL ANN INNERARITY FNP, CNS

Table of content: DR. SHERYL ANN INNERARITY FNP, CNS (NPI 1710165220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710165220 NPI number — DR. SHERYL ANN INNERARITY FNP, CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INNERARITY
Provider First Name:
SHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
FNP, CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INNERARITY
Provider Other First Name:
SHERI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710165220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 FM 2571
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78957-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-360-2031
Provider Business Mailing Address Fax Number:
512-471-3688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 HWY 71 W
Provider Second Line Business Practice Location Address:
B1
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-581-5016
Provider Business Practice Location Address Fax Number:
512-581-5022
Provider Enumeration Date:
02/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  231424 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SA2200X , with the licence number: 231424 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20175797 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".