Healthcare Provider Details

I. General information

NPI: 1053833525
Provider Name (Legal Business Name): JESSICA C CHEATWOOD IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 NW 16TH ST
OKLAHOMA CITY OK
73106-2067
US

IV. Provider business mailing address

1745 NW 16TH ST STE A
OKLAHOMA CITY OK
73106-2078
US

V. Phone/Fax

Practice location:
  • Phone: 405-404-7087
  • Fax:
Mailing address:
  • Phone: 405-404-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL95087
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: