Provider Demographics
NPI:1366923096
Name:CHERRY, CAROL LYNN
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:CHERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6465 W SAHARA AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3071
Mailing Address - Country:US
Mailing Address - Phone:702-684-7800
Mailing Address - Fax:
Practice Address - Street 1:6465 W SAHARA AVE STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3071
Practice Address - Country:US
Practice Address - Phone:702-822-1881
Practice Address - Fax:702-822-1880
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner