Healthcare Provider Details

I. General information

NPI: 1942258322
Provider Name (Legal Business Name): CHERRYL M AVENT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 LAMAR ST
KILMICHAEL MS
39747-9002
US

IV. Provider business mailing address

303 LAMAR ST PO BOX 186
KILMICHAEL MS
39747-9002
US

V. Phone/Fax

Practice location:
  • Phone: 662-262-4284
  • Fax: 662-262-5586
Mailing address:
  • Phone: 662-262-4284
  • Fax: 662-262-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR504696
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR504696
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: