Provider Demographics
NPI:1487876546
Name:CHEATHAM, ANGELA SHARRICE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:SHARRICE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 BOLTON BOONE DRIVE
Mailing Address - Street 2:APARTMENT #704
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:972-780-8908
Mailing Address - Fax:972-723-5592
Practice Address - Street 1:4440 EAST HIGHEAY 287
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:972-723-5590
Practice Address - Fax:972-723-5592
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1004120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily