Basic Information
| Provider Information | |||||||||
| NPI: | 1598209553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COUCH | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | HYDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1641 | ||||||||
| Address2: | |||||||||
| City: | BRYSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287131641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9802795801 | ||||||||
| FaxNumber: | 8285384441 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 OAK ST | ||||||||
| Address2: | |||||||||
| City: | FOREST CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280433585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8289192393 | ||||||||
| FaxNumber: | 8882842932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2016 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5009150 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 5009150 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NCW841J277 | 01 | NC | MEDICARE | OTHER | 1598209553 | 05 | NC | MEDICAID | Q00164251 | 01 | NC | RAILROAD MEDICARE | OTHER | NP7963 | 01 | SC | SC MEDICAID | OTHER | 1332003-0001 | 01 | NC | BWC | OTHER |