Provider Demographics
NPI:1659322923
Name:HICKETHIER, CHERYL BETH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:BETH
Last Name:HICKETHIER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-4947
Mailing Address - Fax:541-574-6252
Practice Address - Street 1:36 SW NYE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3821
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043617Medicaid
OR825072000OtherBLUE CROSS
ORA06628Medicare UPIN
OR043617Medicaid