Healthcare Provider Details

I. General information

NPI: 1568671790
Provider Name (Legal Business Name): CHERYE HEATHER WHITTEMORE ED.S, MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYE HEATHER WHITTEMORE ED.S, MHPP

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 INGRAM BLVD
WEST MEMPHIS AR
72301-3423
US

IV. Provider business mailing address

PO BOX 5692
WEST MEMPHIS AR
72303-5692
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-2737
  • Fax: 870-735-2738
Mailing address:
  • Phone: 870-394-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: