Healthcare Provider Details

I. General information

NPI: 1730112574
Provider Name (Legal Business Name): CHERYL BERNICE KROEKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MAIN ST
CHOUTEAU OK
74337
US

IV. Provider business mailing address

451 S HOLLY ST
SILOAM SPRINGS AR
72761-3018
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-6030
  • Fax: 918-476-6038
Mailing address:
  • Phone: 479-549-3079
  • Fax: 479-549-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4306
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: