Basic Information
| Provider Information | |||||||||
| NPI: | 1245235613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | SHERRY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S 8TH ST STE 480W | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621792 | ||||||||
| FaxNumber: | 2707621783 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S 8TH ST STE 203E | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621562 | ||||||||
| FaxNumber: | 2707522864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 04290027 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363L00000X | 3001671 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 78000270 | 05 | KY | MEDICAID |