Basic Information
| Provider Information | |||||||||
| NPI: | 1568671790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITTEMORE | ||||||||
| FirstName: | CHERYE | ||||||||
| MiddleName: | HEATHER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ED.S, MHPP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHITTEMORE | ||||||||
| OtherFirstName: | CHERYE | ||||||||
| OtherMiddleName: | HEATHER | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ED.S, MHPP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5692 | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723035692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703946344 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 INGRAM BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723013423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707352737 | ||||||||
| FaxNumber: | 8707352738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 373H00000X | AR | Y | Nursing Service Related Providers | Day Training/Habilitation Specialist |
No ID Information.