Provider Demographics
NPI:1356383855
Name:CHEATHAM, LATARSHA SELWYNA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LATARSHA
Middle Name:SELWYNA
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12310 BROKEN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9730
Mailing Address - Country:US
Mailing Address - Phone:281-993-4293
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER ST
Practice Address - Street 2:MC 4-278 BOX 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:713-785-8537
Practice Address - Fax:832-355-6865
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner