Provider Demographics
NPI:1851557920
Name:STOVER, CHERYL DAWN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAWN
Last Name:STOVER
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 1:601 W MAPLE AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5376
Mailing Address - Country:US
Mailing Address - Phone:479-751-3722
Mailing Address - Fax:479-751-1099
Practice Address - Street 1:601 W MAPLE AVE STE 503
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5376
Practice Address - Country:US
Practice Address - Phone:479-751-3722
Practice Address - Fax:479-751-1099
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC002746367500000X
WV077834367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186882001Medicaid