Healthcare Provider Details

I. General information

NPI: 1043168156
Provider Name (Legal Business Name): CHERYL JOLENE ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HERITAGE CIR
PAWNEE OK
74058-3744
US

IV. Provider business mailing address

6313 N COUNTRY CLUB RD UNIT 2
STILLWATER OK
74075-0897
US

V. Phone/Fax

Practice location:
  • Phone: 539-399-0887
  • Fax:
Mailing address:
  • Phone: 469-404-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12809
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: