Provider Demographics
NPI:1942251442
Name:WARNER, CHERYL BURNETTA (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:BURNETTA
Last Name:WARNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:1650 COCHRANE CIR B7500
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:502-264-5232
Mailing Address - Fax:864-654-8027
Practice Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:1650 COCHRANE CIR B7500
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:502-264-5232
Practice Address - Fax:864-654-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC854103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0375Medicaid
SCQ332700281Medicare ID - Type Unspecified