Provider Demographics
NPI:1558513341
Name:WOMACK, CHERIE LYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:LYN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9587 BARKERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9772
Mailing Address - Country:US
Mailing Address - Phone:304-528-5000
Mailing Address - Fax:
Practice Address - Street 1:2850 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1436
Practice Address - Country:US
Practice Address - Phone:304-528-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013122Medicaid