Healthcare Provider Details

I. General information

NPI: 1124611439
Provider Name (Legal Business Name): MEGAN GARDNER CHERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

IV. Provider business mailing address

2900 HAWKINS DR
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-0193
  • Fax:
Mailing address:
  • Phone: 501-278-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124473
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: