Provider Demographics
NPI:1366295339
Name:CHENEY, EMBER NICHOLE
Entity type:Individual
Prefix:
First Name:EMBER
Middle Name:NICHOLE
Last Name:CHENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4655
Mailing Address - Country:US
Mailing Address - Phone:580-309-1799
Mailing Address - Fax:
Practice Address - Street 1:3701 E RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-6609
Practice Address - Country:US
Practice Address - Phone:405-600-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist