Provider Demographics
NPI:1821026329
Name:HENNIGAN, CHERYL W (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:W
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:3340 N COLLEGE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-443-3536
Practice Address - Fax:479-443-3933
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-0103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J506OtherAR BC/BS
AR125701001Medicaid
ARP00184760OtherRR MCR
AR5J506Medicare ID - Type Unspecified
ARP00184760OtherRR MCR
ARB61537Medicare UPIN