Provider Demographics
NPI:1093589269
Name:POPHAM, CHEYANN
Entity Type:Individual
Prefix:
First Name:CHEYANN
Middle Name:
Last Name:POPHAM
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 1:150 TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-1030
Mailing Address - Country:US
Mailing Address - Phone:740-462-2469
Mailing Address - Fax:
Practice Address - Street 1:150 TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-1030
Practice Address - Country:US
Practice Address - Phone:740-462-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver