Provider Demographics
NPI:1194104976
Name:LOVE, SHERRY W (NP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:W
Last Name:LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:276-378-3300
Mailing Address - Fax:276-378-1265
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354
Practice Address - Country:US
Practice Address - Phone:276-378-3300
Practice Address - Fax:276-378-1265
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121357163W00000X
TN20102363LF0000X
VA0024172638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013677Medicaid
VA1194104976Medicaid
TNQ013677Medicaid
VAVVH892B288Medicare PIN
VAVVH892AMedicare PIN
TN103505I990Medicare PIN