Healthcare Provider Details

I. General information

NPI: 1962311522
Provider Name (Legal Business Name): HENRY PARKER CHEATUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BECKER DR
LAWRENCE KS
66047-1620
US

IV. Provider business mailing address

5212 N ROCK RD
BEL AIRE KS
67226-3101
US

V. Phone/Fax

Practice location:
  • Phone: 785-864-3591
  • Fax:
Mailing address:
  • Phone: 316-633-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3-119328
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: