Provider Demographics
NPI:1427147313
Name:SHOULTS, CHERYL ANN
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:SHOULTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30804 CO RD M
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69352
Mailing Address - Country:US
Mailing Address - Phone:308-787-0106
Mailing Address - Fax:
Practice Address - Street 1:152 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240
Practice Address - Country:US
Practice Address - Phone:307-575-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child