Provider Demographics
NPI:1538387089
Name:JOHNSON, SHERRI LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:5 E ALVON ROAD STE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0088
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:ROOM 1025
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-399-7484
Practice Address - Fax:304-399-7579
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84356-20207R00000X
WV22733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1314987OtherCIGNA
WV1073741OtherBRICKSTREET
WV3810009488Medicaid
KY7100022180Medicaid
OH000000246103OtherUNISON/OHIO/HMO
WV2177885OtherUHC
WI1538387089Medicaid
OH2789504Medicaid
WV001910394OtherMTN STATE BCBS
WV1314987OtherCIGNA