MEDICARE: MRS. VALERIE JEAN CHEATHAM A/GNP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	563679	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500000774	OTHER	TX	RAILROAD GBA - RAILROAD MEDICARE
5	P01090515	OTHER	TX	RAILROAD MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	80N446	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1235195595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE JEAN CHEATHAM A/GNP

Provider Business Mailing Address
First Line	:	24275 KATY FWY STE 400
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7267
Country	:	US
Telephone Number	:	346-387-7171
Fax Number	:	844-703-5305

Provider Business Practice Location Address
First Line	:	24275 KATY FWY STE 400
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7267
Country	:	US
Telephone Number	:	346-387-7171
Fax Number	:	844-703-5305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/31/2018

24275 KATY FWY STE 410
KATY, TX
77494-7267

Practice Phone: 855-501-1004
Practice Fax: