Provider Demographics
NPI:1043704455
Name:AYERS, CHASTITY D (FNP)
Entity Type:Individual
Prefix:
First Name:CHASTITY
Middle Name:D
Last Name:AYERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3479 COUNTY ROAD 94
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-4845
Mailing Address - Country:US
Mailing Address - Phone:256-740-9306
Mailing Address - Fax:
Practice Address - Street 1:600 SUN TEMPLE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8643
Practice Address - Country:US
Practice Address - Phone:256-288-3333
Practice Address - Fax:256-288-3334
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily