Provider Demographics
NPI:1215952965
Name:MISSILDINE, SHERRY LYNN (RN, MSN, ACNP-BC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:MISSILDINE
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-BC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:PORIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, ACNP-BC
Mailing Address - Street 1:4743 ARAPAHOE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1128
Mailing Address - Country:US
Mailing Address - Phone:303-835-0936
Mailing Address - Fax:303-998-0007
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 302B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5228
Practice Address - Country:US
Practice Address - Phone:903-614-5180
Practice Address - Fax:903-614-5169
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704242363LA2100X
TXAP115139363LA2100X
CO658363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1F7305OtherMCR PIN - CTC
TX197789401Medicaid
TX8Y8806OtherBCBS
OK200223530AMedicaid