Provider Demographics
NPI:1962438762
Name:LUMMIS, CHERYL G (APRN,CDE)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:G
Last Name:LUMMIS
Suffix:
Gender:F
Credentials:APRN,CDE
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:G
Other - Last Name:ELLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 KELLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3811
Mailing Address - Country:US
Mailing Address - Phone:573-582-1234
Mailing Address - Fax:
Practice Address - Street 1:340 KELLEY PKWY
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3811
Practice Address - Country:US
Practice Address - Phone:573-582-1234
Practice Address - Fax:573-582-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143916163WD0400X
MO2012005566364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012005566OtherCLINICAL NURSE SPECIALIST
MO2041-0485OtherCERTIFIED DIABETES EDUCA
MO143916OtherNURSING LICENSE