Provider Demographics
NPI:1700196748
Name:GARY, CHERYL LYNN (RN, BSN, MSN, FNP,BC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:GARY
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HWY 83
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201
Mailing Address - Country:US
Mailing Address - Phone:940-937-9181
Mailing Address - Fax:940-937-9133
Practice Address - Street 1:901 HWY 83
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201
Practice Address - Country:US
Practice Address - Phone:940-937-9181
Practice Address - Fax:940-937-9133
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX241376OtherTEXAS RN LICENSE ADVANCED