Provider Demographics
NPI:1568671790
Name:WHITTEMORE, CHERYE HEATHER (EDS, MHPP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYE
Middle Name:HEATHER
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:EDS, MHPP
Other - Prefix:MRS
Other - First Name:CHERYE
Other - Middle Name:HEATHER
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDS, MHPP
Mailing Address - Street 1:PO BOX 5692
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-5692
Mailing Address - Country:US
Mailing Address - Phone:870-394-6344
Mailing Address - Fax:
Practice Address - Street 1:205 INGRAM BLVD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3423
Practice Address - Country:US
Practice Address - Phone:870-735-2737
Practice Address - Fax:870-735-2738
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist