Provider Demographics
NPI:1447808373
Name:SPELL, CHERYL (FNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10588 BONWELL LOOP
Mailing Address - Street 2:
Mailing Address - City:KOUNTZE
Mailing Address - State:TX
Mailing Address - Zip Code:77625-6035
Mailing Address - Country:US
Mailing Address - Phone:409-790-0270
Mailing Address - Fax:
Practice Address - Street 1:3650 N MAJOR DR STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9684
Practice Address - Country:US
Practice Address - Phone:409-333-1272
Practice Address - Fax:409-333-1278
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty