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General NPI Number Information
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NPI Number | 1972699197
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Entity Type | Individual
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Provider Name | CHERI D LEARY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 1453 E BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105-6800
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Country | US
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Telephone | 318-681-4138
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Fax | 318-681-5157
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Provider Business Mailing Address
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Address Line | 2900 SAINT MICHAEL DR STE 401
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City | TEXARKANA
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State | TX
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Zip | 75503-5211
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Country | US
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Telephone | 903-614-5372
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Fax | 903-614-5343
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA200093
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License Number State | LA
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