Individual
CHERYL ANN MARBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-2005
Mailing address
504 CLINTON CENTER DR STE 4300, CLINTON, MS 39056-5610
(601) 815-2005
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R844765
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02975011
MS MEDICAID
MS
Enumeration date
07/04/2006
Last updated
12/01/2022
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