Basic Information
| Provider Information | |||||||||
| NPI: | 1891737896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 433 GRAYSON DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372053046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153526405 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 FREY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157921199 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000006944 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3905412 | 05 | TN | MEDICAID |