Provider Demographics
NPI:1740477025
Name:HARVEY, CHERYL VONCILLE (CRNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:VONCILLE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:VONCILLE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:251 N BAYOU ST
Mailing Address - Street 2:P O BOX 2867
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5827
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:4555 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3563
Practice Address - Country:US
Practice Address - Phone:251-456-1399
Practice Address - Fax:251-456-0079
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-045566363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0389275-22OtherANCC
AL011846OtherMEDICARE GROUP NUMBER
AL1063439065OtherNPI SITE GROUP PAYEE NUMBER
AL630000013Medicaid