Provider Demographics
NPI:1295256378
Name:LEDSOME, CHERI L (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:L
Last Name:LEDSOME
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 RUTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1740
Mailing Address - Country:US
Mailing Address - Phone:602-697-9358
Mailing Address - Fax:
Practice Address - Street 1:1055 RUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1740
Practice Address - Country:US
Practice Address - Phone:928-515-2443
Practice Address - Fax:928-227-2496
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10119363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty