Provider Demographics
NPI:1427270479
Name:BEALL, SHERROD ANN (NP)
Entity type:Individual
Prefix:MS
First Name:SHERROD
Middle Name:ANN
Last Name:BEALL
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 1:9197 GRANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4329
Mailing Address - Country:US
Mailing Address - Phone:303-565-5261
Mailing Address - Fax:
Practice Address - Street 1:401 N DOLORES RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-4213
Practice Address - Country:US
Practice Address - Phone:970-565-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN85938363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19489340Medicaid