Provider Demographics
NPI:1164414561
Name:WHITE, CHERYL L (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:C-FNP
Mailing Address - Street 1:497 MALL RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-6115
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-645-1518
Practice Address - Street 1:315 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1086
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001807Medicaid
WV3810001807Medicaid
WVNP77672Medicare PIN
WVQ31458Medicare UPIN