Healthcare Provider Details

I. General information

NPI: 1740477025
Provider Name (Legal Business Name): CHERYL VONCILLE HARVEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL VONCILLE RICHARDSON CRNP

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 SAINT STEPHENS RD
EIGHT MILE AL
36613-3563
US

IV. Provider business mailing address

251 N BAYOU ST P O BOX 2867
MOBILE AL
36603-5827
US

V. Phone/Fax

Practice location:
  • Phone: 251-456-1399
  • Fax: 251-456-0079
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-544-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-045566
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-045566
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: