Provider Demographics
NPI:1134157944
Name:CHEATHAM, TRACY J (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:JONES
Other - Last Name:LANGEBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4038 THOMAS NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22922-2302
Mailing Address - Country:US
Mailing Address - Phone:434-263-4000
Mailing Address - Fax:434-263-4160
Practice Address - Street 1:4038 THOMAS NELSON HWY
Practice Address - Street 2:
Practice Address - City:ARRINGTON
Practice Address - State:VA
Practice Address - Zip Code:22922-2302
Practice Address - Country:US
Practice Address - Phone:434-263-4000
Practice Address - Fax:434-263-4160
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166184363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006011L93Medicare ID - Type Unspecified