Provider Demographics
NPI:1548929920
Name:BROWN, SHERRY MICHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:MICHELLE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1401 UNIVERSITY BLVD APT A3
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-8460
Mailing Address - Country:US
Mailing Address - Phone:423-306-0151
Mailing Address - Fax:
Practice Address - Street 1:1797 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3226
Practice Address - Country:US
Practice Address - Phone:423-860-0516
Practice Address - Fax:423-860-0517
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ071886Medicaid