Provider Demographics
NPI:1932936846
Name:MARSHALL, SYDNEY (FNP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SHADYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-7448
Mailing Address - Country:US
Mailing Address - Phone:606-813-2227
Mailing Address - Fax:
Practice Address - Street 1:1031 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9240
Practice Address - Country:US
Practice Address - Phone:606-919-1901
Practice Address - Fax:606-919-1904
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4027621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily