Healthcare Provider Details

I. General information

NPI: 1487578688
Provider Name (Legal Business Name): CAROLYN CHEATHAM NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13354 MIDLOTHIAN TPKE STE 102
MIDLOTHIAN VA
23113-4258
US

IV. Provider business mailing address

13354 MIDLOTHIAN TPKE STE 102
MIDLOTHIAN VA
23113-4258
US

V. Phone/Fax

Practice location:
  • Phone: 804-606-7321
  • Fax: 800-776-3115
Mailing address:
  • Phone: 804-606-7321
  • Fax: 800-776-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN K CHEATHAM
Title or Position: OWNER
Credential: NP
Phone: 804-606-7321