Provider Demographics
NPI:1013937168
Name:ALLEN, CHERYL A (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE, STE 1003
Mailing Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5611
Mailing Address - Country:US
Mailing Address - Phone:912-315-3991
Mailing Address - Fax:912-315-4927
Practice Address - Street 1:1061 HARMON AVE, STE 1003
Practice Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5611
Practice Address - Country:US
Practice Address - Phone:912-315-3991
Practice Address - Fax:912-315-4927
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN133571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00630134OtherRR MEDICARE
GA000968723CMedicaid
GA50BBGGPOtherMEDICARE ID - OLD CANDLER GROUP
GAP00630134OtherRR MEDICARE
GA511I500540Medicare PIN