Provider Demographics
NPI:1306838602
Name:KELLEY, CHERYL ANN (NP)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:ANN
Last Name:KELLEY
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 1:1407 SUNNYVALE ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-1922
Mailing Address - Country:US
Mailing Address - Phone:325-933-4224
Mailing Address - Fax:
Practice Address - Street 1:5311 BIG SPRING HWY
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6347
Practice Address - Country:US
Practice Address - Phone:325-776-2500
Practice Address - Fax:325-776-2355
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80N426OtherMEDICARE PART B
TX80N426OtherMEDICARE PART B
TXR98645Medicare UPIN