Provider Demographics
NPI:1487785366
Name:CHEATWOOD-JOHNSTON, AMY B (DC, APRN-CNP, FNP)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:B
Last Name:CHEATWOOD-JOHNSTON
Suffix:
Gender:F
Credentials:DC, APRN-CNP, FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:B
Other - Last Name:CHEATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140
Mailing Address - Country:US
Mailing Address - Phone:719-274-5000
Mailing Address - Fax:
Practice Address - Street 1:610 PATTERSON LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-1392
Practice Address - Country:US
Practice Address - Phone:479-857-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1313111N00000X
OK0101849363LF0000X
CO0992020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor