Provider Demographics
NPI:1154320588
Name:SWAYNE, CHERYL (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SWAYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 FOXBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-9001
Mailing Address - Country:US
Mailing Address - Phone:859-356-1687
Mailing Address - Fax:
Practice Address - Street 1:3188 FOXBOURNE LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-9001
Practice Address - Country:US
Practice Address - Phone:859-356-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1019P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045389OtherANTHEM
KY78009255Medicaid
KYNP019POtherCHOICE CARE
KY0294613Medicare ID - Type Unspecified
KY0398444Medicare PIN
KYS40013Medicare UPIN