Provider Demographics
NPI:1740728385
Name:HERNANDEZ, CHERYL (ACAGNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ACAGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 HEBRON PARK DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9548
Mailing Address - Country:US
Mailing Address - Phone:859-429-3333
Mailing Address - Fax:859-869-0248
Practice Address - Street 1:2940 HEBRON PARK DR STE 301
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9548
Practice Address - Country:US
Practice Address - Phone:859-429-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020540363LA2200X, 363LA2200X
KY3009769363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0239546Medicaid