Provider Demographics
NPI:1578155073
Name:NESOM, CHERI PHELPS (RN NURSE CASE MANAGE)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:PHELPS
Last Name:NESOM
Suffix:
Gender:F
Credentials:RN NURSE CASE MANAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 3RD ST.,
Mailing Address - Street 2:ATTENTION: CREDENTIALS ROOM
Mailing Address - City:FT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:337-531-4253
Mailing Address - Fax:337-531-4314
Practice Address - Street 1:1585 3RD STREET
Practice Address - Street 2:ATTENTION: CREDENTIALS ROOM
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-4253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA113770163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management