Healthcare Provider Details

I. General information

NPI: 1124145461
Provider Name (Legal Business Name): CHERYL CHEEK CARROLL CNM, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E CARVER ST
DURHAM NC
27704-2133
US

IV. Provider business mailing address

PO BOX 51224
DURHAM NC
27717-1224
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-2273
  • Fax: 919-479-0881
Mailing address:
  • Phone: 919-493-6523
  • Fax: 919-479-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5002178
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: