1568671790 NPI number — MRS. CHERYE HEATHER WHITTEMORE ED.S, MHPP

Table of content: MRS. CHERYE HEATHER WHITTEMORE ED.S, MHPP (NPI 1568671790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568671790 NPI number — MRS. CHERYE HEATHER WHITTEMORE ED.S, MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTEMORE
Provider First Name:
CHERYE
Provider Middle Name:
HEATHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S, MHPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITTEMORE
Provider Other First Name:
CHERYE
Provider Other Middle Name:
HEATHER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.S, MHPP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568671790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72303-5692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-394-6344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 INGRAM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-735-2737
Provider Business Practice Location Address Fax Number:
870-735-2738
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 373H00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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