Healthcare Provider Details

I. General information

NPI: 1487785366
Provider Name (Legal Business Name): AMY B. CHEATWOOD-JOHNSTON D.C., APRN-CNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY B CHEATWOOD

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PATTERSON LN
RUSSELLVILLE AR
72802-1392
US

IV. Provider business mailing address

509 MAIN STREET
LA JARA CO
81140
US

V. Phone/Fax

Practice location:
  • Phone: 479-857-9766
  • Fax:
Mailing address:
  • Phone: 719-274-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0101849
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992020
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1313
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: