Provider Demographics
NPI:1538263827
Name:RICH, CHERYLL DARLINE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYLL
Middle Name:DARLINE
Last Name:RICH
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 1:2002 KANELL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4042
Mailing Address - Country:US
Mailing Address - Phone:573-727-9130
Mailing Address - Fax:573-727-9128
Practice Address - Street 1:2002 KANELL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4042
Practice Address - Country:US
Practice Address - Phone:573-727-9130
Practice Address - Fax:573-727-9128
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO164720OtherBLUE CROSS-BLUE SHIELD
MO204689012Medicaid
MO520943OtherHEALTHLINK
MO2253997OtherUNITED HEALTH CARE
MO937880497Medicare ID - Type Unspecified
MO204689012Medicaid