MEDICARE: MRS. WILMA LYNNE CHERRY FNP-LPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	579822	TX

General Provider Information

NPI Number	:	1386862027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WILMA LYNNE CHERRY FNP-LPA

Provider Business Mailing Address
First Line	:	2285 WORTH ST
Second Line	:	P O BOX 1947
City	:	HEMPHILL
State	:	TX
Zip	:	75948-7217
Country	:	US
Telephone Number	:	409-787-3520
Fax Number	:	409-787-1423

Provider Business Practice Location Address
First Line	:	103 TIMBERLAND HWY. WEST
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968
Country	:	US
Telephone Number	:	409-584-9933
Fax Number	:	409-584-1754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/12/2013

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