Provider Demographics
NPI:1528457306
Name:FRANKLIN, SHERRY (ANP-BC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MADISON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4746
Mailing Address - Country:US
Mailing Address - Phone:618-876-8214
Mailing Address - Fax:618-451-9111
Practice Address - Street 1:11155 DUNN RD STE 304E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6111
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-741-0501
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012205363LA2200X
MO2014035975363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528457306Medicaid