| Doctor Name: | JACKIE LEON CHEATHAM |
| NPI Number: | 1225348980 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | EMT |
| License Number: | 16847 |
| Business Practice Address: | 907 Ar Hwy 56 Calico Rock, AR - 725190261 |
| Business Phone Number: | 8704219494 |
| Business Fax Number: | |
| Mailing Address: | Po Box 261, 907 Ar Hwy 56 CALICO ROCK |
| State: | AR |
| Postal Code: | 725190261 |
| Phone Number: | 8704219494 |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2010 |
| NPI Last Update Date: | 10/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146N00000X |
| License Number: | 16847 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Basic |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |