Provider Demographics
NPI:1457956864
Name:CHEATHAM, HELEN K
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:K
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIFFERENT
Other - Middle Name:IS
Other - Last Name:BEAUTIFUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:545 VIA AMALFI APT 312
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2863
Mailing Address - Country:US
Mailing Address - Phone:317-506-4426
Mailing Address - Fax:
Practice Address - Street 1:545 VIA AMALFI APT 312
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2863
Practice Address - Country:US
Practice Address - Phone:317-506-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker