Provider Demographics
NPI:1730112574
Name:KROEKER, CHERYL BERNICE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:BERNICE
Last Name:KROEKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3018
Mailing Address - Country:US
Mailing Address - Phone:479-549-3079
Mailing Address - Fax:479-549-3275
Practice Address - Street 1:108 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337
Practice Address - Country:US
Practice Address - Phone:918-476-6030
Practice Address - Fax:918-476-6038
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075950DMedicaid
OK$$$$$$$$$OtherOKLAHOMA BCBS
OK200075950CMedicaid
OK200075950AMedicaid
OK200075950DMedicaid
OK200075950CMedicaid
OKOKAAA0590Medicare PIN