=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538323969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERILYN LORRAINE HEBERT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2008
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1281 HIGHWAY 51
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-9092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-853-5592
-----------------------------------------------------
Fax | 877-745-5458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1271
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39215-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-853-5592
-----------------------------------------------------
Fax | 877-745-5458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | 08742
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------