Provider Demographics
NPI:1598707929
Name:C & K NURSE PRACTITIONER SERVICES, PC
Entity Type:Organization
Organization Name:C & K NURSE PRACTITIONER SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:254-749-4298
Mailing Address - Street 1:415 EASY ST
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661
Mailing Address - Country:US
Mailing Address - Phone:512-300-2455
Mailing Address - Fax:
Practice Address - Street 1:415 EASY ST
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661
Practice Address - Country:US
Practice Address - Phone:512-300-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00954UOtherBCBS TX GROUP #
TX158458301Medicaid
TX00954UMedicare ID - Type UnspecifiedMCB GROUP #