Healthcare Provider Details

I. General information

NPI: 1033039078
Provider Name (Legal Business Name): CHERYL DAVIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5107
US

IV. Provider business mailing address

2417 E MADISON ST
OKLAHOMA CITY OK
73111-3525
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-408-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: