Provider Demographics
NPI:1689263469
Name:BAINES, CHERYL LYNN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:BAINES
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 1:306 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-5512
Mailing Address - Country:US
Mailing Address - Phone:979-997-1944
Mailing Address - Fax:
Practice Address - Street 1:306 S EAST AVE
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-5512
Practice Address - Country:US
Practice Address - Phone:979-997-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-4808608Medicaid