Provider Demographics
NPI:1851988604
Name:MONDICS, CHERISHE PAYNE
Entity Type:Individual
Prefix:
First Name:CHERISHE
Middle Name:PAYNE
Last Name:MONDICS
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 1:139 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-4802
Mailing Address - Country:US
Mailing Address - Phone:806-239-5716
Mailing Address - Fax:
Practice Address - Street 1:2801 BOLTON BOONE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2041
Practice Address - Country:US
Practice Address - Phone:972-298-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1017566363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner