Provider Demographics
NPI:1083122113
Name:HAMILTON, CHERYL V (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:V
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:V
Other - Last Name:ECHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:622 COLLINS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-638-1506
Mailing Address - Fax:636-638-1507
Practice Address - Street 1:1051 JONES ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3866
Practice Address - Country:US
Practice Address - Phone:573-888-0030
Practice Address - Fax:573-888-0040
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017040911163W00000X
AL1-083308163W00000X
MO2017044030363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse