Provider Demographics
NPI:1063432094
Name:SHANKS, CHERYL E (ARNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:SHANKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RAPIDS
Mailing Address - State:KS
Mailing Address - Zip Code:66411-1419
Mailing Address - Country:US
Mailing Address - Phone:785-363-7202
Mailing Address - Fax:785-363-7630
Practice Address - Street 1:607 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BLUE RAPIDS
Practice Address - State:KS
Practice Address - Zip Code:66411-1419
Practice Address - Country:US
Practice Address - Phone:785-363-7202
Practice Address - Fax:785-363-7630
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160788OtherBC/BS KS
KS425760OtherFIRST GUARD
160788Medicare ID - Type Unspecified
KS425760OtherFIRST GUARD