Provider Demographics
NPI:1093203283
Name:CHERUIYOT, FREDRICK K
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:K
Last Name:CHERUIYOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PRESTON ON THE LK TRLR 401
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5733
Mailing Address - Country:US
Mailing Address - Phone:214-558-9066
Mailing Address - Fax:
Practice Address - Street 1:1800 PRESTON ON THE LK TRLR 401
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5733
Practice Address - Country:US
Practice Address - Phone:214-558-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304320164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse