Provider Demographics
NPI:1194097717
Name:CHEATWOOD, DARLA JO (RN, BSN)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:JO
Last Name:CHEATWOOD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-1425
Mailing Address - Country:US
Mailing Address - Phone:918-716-8632
Mailing Address - Fax:918-758-1270
Practice Address - Street 1:100 E 7TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4606
Practice Address - Country:US
Practice Address - Phone:918-758-1910
Practice Address - Fax:918-758-1270
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR57641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse