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General NPI Number Information
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NPI Number | 1043168156
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Entity Type | Individual
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Provider Name | CHERYL JOLENE ROBERTSON
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Gender | Female
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 1201 HERITAGE CIR
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City | PAWNEE
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State | OK
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Zip | 74058-3744
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Country | US
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Telephone | 539-399-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 N COUNTRY CLUB RD UNIT 2
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City | STILLWATER
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State | OK
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Zip | 74075-0897
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Country | US
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Telephone | 469-404-0515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 12809
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License Number State | KS
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