Provider Demographics
NPI:1447906482
Name:DAVIS, CHEYENNE DAWN
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21733 TROON LN
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9612
Mailing Address - Country:US
Mailing Address - Phone:479-427-2474
Mailing Address - Fax:
Practice Address - Street 1:1500 CHERI WHITLOCK DR
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9100
Practice Address - Country:US
Practice Address - Phone:479-524-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRBT-21-181208106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician