Provider Demographics
NPI:1760457345
Name:WAGES CORNELL, SHERI L (PA-C)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:L
Last Name:WAGES CORNELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:LYNNE
Other - Last Name:WAGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 910221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0221
Mailing Address - Country:US
Mailing Address - Phone:928-775-9430
Mailing Address - Fax:
Practice Address - Street 1:5430 LANDMARK LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-0019
Practice Address - Country:US
Practice Address - Phone:928-775-9430
Practice Address - Fax:928-775-9431
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159355OtherL AND I
WA8252504Medicaid
AB33709Medicare UPIN
WA0159355OtherL AND I