Provider Demographics
NPI:1386114346
Name:GUYNUP, SHERRY L
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:GUYNUP
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 1:1515 SE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-7509
Mailing Address - Country:US
Mailing Address - Phone:682-319-7965
Mailing Address - Fax:
Practice Address - Street 1:1515 SE 18TH ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-7509
Practice Address - Country:US
Practice Address - Phone:682-319-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208364164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse