Provider Demographics
NPI:1598104689
Name:RABALAIS, CHERYL DENISE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:RABALAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 KELLEY RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9186
Mailing Address - Country:US
Mailing Address - Phone:870-304-2543
Mailing Address - Fax:
Practice Address - Street 1:124 RAY LOCHALA RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4542
Practice Address - Country:US
Practice Address - Phone:870-364-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199692758Medicaid
AR199692758Medicaid