Provider Demographics
NPI:1083208664
Name:FALLS, CHASITI JORDAN (CNM)
Entity Type:Individual
Prefix:MS
First Name:CHASITI
Middle Name:JORDAN
Last Name:FALLS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:CHASITI
Other - Middle Name:FALLS
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:105 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-8926
Mailing Address - Country:US
Mailing Address - Phone:704-974-6032
Mailing Address - Fax:
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-671-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife