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Individual

CHERYL W HENNIGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3340 N COLLEGE AVE, SUITE 5, FAYETTEVILLE, AR 72703
(479) 443-3536
(479) 443-3933
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-0103
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
125701001
AR
01
5J506
AR BC/BS
AR
01
P00184760
RR MCR
AR
Enumeration date
06/30/2006
Last updated
07/25/2023
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