Provider Demographics
NPI:1033812607
Name:DELAVEGA, CHASITY (APRN)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:DELAVEGA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:HILLVIEW
Mailing Address - State:KY
Mailing Address - Zip Code:40129-0592
Mailing Address - Country:US
Mailing Address - Phone:502-994-4751
Mailing Address - Fax:
Practice Address - Street 1:4400 BRECKENRIDGE LN STE 147
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4175
Practice Address - Country:US
Practice Address - Phone:502-708-1904
Practice Address - Fax:502-708-2547
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011523363LF0000X
KY1140771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse