Provider Demographics
NPI:1124578216
Name:WAGERS, CHERI LYNN (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:WAGERS
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1501 HIGHWAY 1524
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-9011
Mailing Address - Country:US
Mailing Address - Phone:606-658-2323
Mailing Address - Fax:606-658-2323
Practice Address - Street 1:90 GARRARD SQ
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-658-2323
Practice Address - Fax:606-658-6085
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100447310Medicaid