Healthcare Provider Details

I. General information

NPI: 1528012762
Provider Name (Legal Business Name): CHERYL LYNN STOCKETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2287 S MOUNTAINEER HWY
THORNTON WV
26440-7171
US

IV. Provider business mailing address

2287 S MOUNTAINEER HWY
THORNTON WV
26440-7171
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-6963
  • Fax: 304-265-6961
Mailing address:
  • Phone: 304-265-6963
  • Fax: 304-265-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21656
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: