Provider Demographics
NPI:1275525354
Name:CHEEK, CARLA RENEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:RENEE
Last Name:CHEEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:RENEE
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2 SHERIDAN SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7399
Mailing Address - Country:US
Mailing Address - Phone:423-392-2887
Mailing Address - Fax:423-246-8278
Practice Address - Street 1:2 SHERIDAN SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7399
Practice Address - Country:US
Practice Address - Phone:423-392-2887
Practice Address - Fax:423-246-8278
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I4172Medicare PIN
P91016Medicare UPIN
TN3348675Medicare PIN