Provider Demographics
NPI:1518070283
Name:CALVIN, CHERYL (APRN, BC FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CALVIN
Suffix:
Gender:F
Credentials:APRN, BC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OLD MILL LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65752-7173
Mailing Address - Country:US
Mailing Address - Phone:417-637-5458
Mailing Address - Fax:
Practice Address - Street 1:101 W PATTERSON ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1054
Practice Address - Country:US
Practice Address - Phone:417-466-7700
Practice Address - Fax:417-466-7754
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO64430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000000000OtherNO NUMER AVAILABLE