Provider Demographics
NPI:1659058139
Name:STODDARD, CHERYL ANN
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:STODDARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODFORD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2180
Mailing Address - Country:US
Mailing Address - Phone:571-266-2635
Mailing Address - Fax:
Practice Address - Street 1:762 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3413
Practice Address - Country:US
Practice Address - Phone:775-738-5850
Practice Address - Fax:775-738-5856
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187416363L00000X, 363LF0000X
NV885140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily