Provider Demographics
NPI:1134543895
Name:EVANS, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:EVANS
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:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:OKAY
Mailing Address - State:OK
Mailing Address - Zip Code:74446-0545
Mailing Address - Country:US
Mailing Address - Phone:918-681-4413
Mailing Address - Fax:
Practice Address - Street 1:1700 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3340
Practice Address - Country:US
Practice Address - Phone:918-681-4201
Practice Address - Fax:918-686-8445
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator