Provider Demographics
NPI:1801177225
Name:COOPER-DYE, SHERRY L (CNP DNP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:COOPER-DYE
Suffix:
Gender:F
Credentials:CNP DNP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1365 EBER LEA VIS
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8136
Mailing Address - Country:US
Mailing Address - Phone:614-327-5327
Mailing Address - Fax:
Practice Address - Street 1:1365 EBER LEA VIS
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8136
Practice Address - Country:US
Practice Address - Phone:614-327-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN229100COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2293969Medicaid