Provider Demographics
NPI:1376266437
Name:CHEATHAM, JERICA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JERICA
Middle Name:
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-933-0998
Practice Address - Street 1:933 W RACE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2123
Practice Address - Country:US
Practice Address - Phone:865-882-0105
Practice Address - Fax:833-908-2083
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2022066506363L00000X
TN32664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner