Provider Demographics
NPI:1922106319
Name:GILBREATH, CHERYL (RN,GNP,ANP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:RN,GNP,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EASY ST
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-2336
Mailing Address - Country:US
Mailing Address - Phone:512-300-2455
Mailing Address - Fax:512-300-2454
Practice Address - Street 1:415 EASY ST
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-2336
Practice Address - Country:US
Practice Address - Phone:512-300-2455
Practice Address - Fax:512-300-2454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533884163W00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS39222Medicare UPIN
TX8A5929Medicare ID - Type Unspecified