Provider Demographics
NPI:1194553370
Name:CHERRY, RAVEN (RN)
Entity type:Individual
Prefix:MRS
First Name:RAVEN
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3937
Mailing Address - Country:US
Mailing Address - Phone:870-534-1834
Mailing Address - Fax:870-534-5798
Practice Address - Street 1:2500 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3937
Practice Address - Country:US
Practice Address - Phone:870-534-1834
Practice Address - Fax:870-534-5798
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse