Provider Demographics
NPI:1447693684
Name:SMOKE, SHERYL LYNN (NP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:LYNN
Last Name:SMOKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:LYNN
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5713
Mailing Address - Country:US
Mailing Address - Phone:503-908-1289
Mailing Address - Fax:503-908-3439
Practice Address - Street 1:10121 SE SUNNYSIDE RD STE 300
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5713
Practice Address - Country:US
Practice Address - Phone:503-908-1289
Practice Address - Fax:503-908-3439
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201350047NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000000000187240OtherBLUE CROSS BLUE SHIELD