Provider Demographics
NPI:1104541366
Name:GRIFFIN, SHERMETRA N
Entity type:Individual
Prefix:
First Name:SHERMETRA
Middle Name:N
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-1129
Mailing Address - Country:US
Mailing Address - Phone:972-748-6973
Mailing Address - Fax:
Practice Address - Street 1:198 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-1129
Practice Address - Country:US
Practice Address - Phone:972-748-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator