Basic Information
Provider Information | |||||||||
NPI: | 1942538327 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAYO | ||||||||
FirstName: | SHERI | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4214 ANDREWS HWY STE 240 | ||||||||
Address2: |   | ||||||||
City: | MIDLAND | ||||||||
State: | TX | ||||||||
PostalCode: | 797034817 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4326866605 | ||||||||
FaxNumber: | 4326822284 | ||||||||
Practice Location | |||||||||
Address1: | 1805 S COUNTY RD 1105 | ||||||||
Address2: | STE D & E | ||||||||
City: | MIDLAND | ||||||||
State: | TX | ||||||||
PostalCode: | 797065120 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4322211325 | ||||||||
FaxNumber: | 4322211324 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/24/2009 | ||||||||
LastUpdateDate: | 08/04/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/04/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X |   | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 079837301 | 05 | TX |   | MEDICAID |