Individual
CHERYL PREMILA SPEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3224 S 70TH ST, FORT SMITH, AR 72903-5050
(479) 314-4810
(479) 314-4829
Mailing address
2901 S 74TH ST, FORT SMITH, AR 72903-5156
(479) 314-1101
(479) 314-4704
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
BP10037147
TX
208000000X
Pediatrics Physician
Primary
E-9186
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200601840A
MEDICAID SOONERCARE
—
05
—
200601840A
—
OK
05
—
209981003
—
AR
01
—
2487
TN MEDICAL LIC
TN
05
—
Q001054
—
TN
Enumeration date
04/15/2010
Last updated
07/21/2022
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