Provider Demographics
NPI:1235195595
Name:CHEATHAM, VALERIE JEAN (A/GNP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JEAN
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:A/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24275 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7267
Mailing Address - Country:US
Mailing Address - Phone:346-387-7171
Mailing Address - Fax:844-703-5305
Practice Address - Street 1:24275 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7267
Practice Address - Country:US
Practice Address - Phone:346-387-7171
Practice Address - Fax:844-703-5305
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563679363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX500000774OtherRAILROAD GBA - RAILROAD MEDICARE
TX038004002Medicaid
TX80N446OtherBCBS
TX038004001Medicaid
TXP01090515OtherRAILROAD MEDICARE PTAN
TX038004002Medicaid
TX80N446OtherBCBS
TXTXB151012Medicare PIN