Provider Demographics
NPI:1811647571
Name:LAUDERDALE, CHERYL LYNN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:LAUDERDALE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1837 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-4401
Mailing Address - Country:US
Mailing Address - Phone:903-910-2294
Mailing Address - Fax:
Practice Address - Street 1:1837 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-4401
Practice Address - Country:US
Practice Address - Phone:903-910-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073549363LF0000X
TX858522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse