Provider Demographics
NPI:1528043106
Name:GROOMS, SHERRY SUZANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:SUZANNE
Last Name:GROOMS
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 1:6021 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9163
Mailing Address - Country:US
Mailing Address - Phone:937-864-0503
Mailing Address - Fax:
Practice Address - Street 1:3572 DAYTON XENIA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2886
Practice Address - Country:US
Practice Address - Phone:937-427-4600
Practice Address - Fax:937-427-4520
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH263353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner