Provider Demographics
NPI:1669984845
Name:CHEATWOOD, JOHN D (CRNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:CHEATWOOD
Suffix:
Gender:M
Credentials:CRNP, 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:PO BOX 732892
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1836
Mailing Address - Country:US
Mailing Address - Phone:850-469-3500
Mailing Address - Fax:
Practice Address - Street 1:305 CORDAY ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2214
Practice Address - Country:US
Practice Address - Phone:448-227-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health