Basic Information
Provider Information
NPI: 1396305777
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERFEY
FirstName: ALEXIS
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1301 N RACE ST
Address2:  
City: GLASGOW
State: KY
PostalCode: 421413454
CountryCode: US
TelephoneNumber: 2706514325
FaxNumber: 2706514672
Practice Location
Address1: 1301 N RACE ST
Address2:  
City: GLASGOW
State: KY
PostalCode: 421413454
CountryCode: US
TelephoneNumber: 2706514325
FaxNumber: 2706514672
Other Information
ProviderEnumerationDate: 06/18/2019
LastUpdateDate: 04/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3013484KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
710060180005KY MEDICAID


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