Provider Demographics
NPI:1174084057
Name:BRACKETT, CHERISE GREEN (MD)
Entity type:Individual
Prefix:
First Name:CHERISE
Middle Name:GREEN
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 THUNDER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7672
Mailing Address - Country:US
Mailing Address - Phone:252-334-0460
Mailing Address - Fax:844-518-0705
Practice Address - Street 1:905 THUNDER RD STE 210
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7672
Practice Address - Country:US
Practice Address - Phone:252-334-0460
Practice Address - Fax:844-518-0705
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA135177208000000X
NC1351772080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics