Healthcare Provider Details

I. General information

NPI: 1124081849
Provider Name (Legal Business Name): CHERYL ANN HULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 52ND ST
ROGERS AR
72758-8600
US

IV. Provider business mailing address

500 S 52ND ST
ROGERS AR
72758-8600
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-9662
  • Fax: 479-254-9652
Mailing address:
  • Phone: 479-254-9662
  • Fax: 479-254-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE3069
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberBH7561409
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: