Cherry Lacreta Bowen, ATC, LAT
Individual provider Active NPI Athletic Trainer · Alva, OK
NPI 1114473873 · NPPES record last updated Mar 20, 2018
Key facts
- NPI
- 1114473873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 743 (OK)
- Practice address
- 709 E Oklahoma Blvd
Alva, OK 73717-7371 - Phone
- (361) 227-7355
- NPI assigned
- Aug 31, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 743 | OK | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 743 | OK | Yes |
Addresses
Primary practice location
709 E Oklahoma Blvd
Alva, OK 73717-7371
Mailing address
709 Oklahoma Blvd
Alva, OK 73717-2749
Phone (361) 227-7355
Other practice location 1
609 Labbe
San Diego, TX 78384-2661
Phone (361) 227-7355
Other providers in Alva, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.