Provider Demographics
NPI:1417941410
Name:VALLIE, CHERYL J (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:VALLIE
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 1:3423 CALDERA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2825
Mailing Address - Country:US
Mailing Address - Phone:432-699-6271
Mailing Address - Fax:432-699-6296
Practice Address - Street 1:3423 CALDERA BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2825
Practice Address - Country:US
Practice Address - Phone:432-699-6271
Practice Address - Fax:432-699-6296
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092873105Medicaid
TX092873105Medicaid
S40101Medicare UPIN