Provider Demographics
NPI:1417683897
Name:MANNING, CHEYENNE CHARLOTTE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CHARLOTTE
Last Name:MANNING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CLOVERLAND RD APT 304
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5994
Mailing Address - Country:US
Mailing Address - Phone:443-205-3804
Mailing Address - Fax:
Practice Address - Street 1:1875 MILLIKIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2200
Practice Address - Country:US
Practice Address - Phone:614-292-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007512RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant