Provider Demographics
NPI:1235815226
Name:MAYES, CHASITY NICHOLE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:NICHOLE
Last Name:MAYES
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 1:5976 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7991
Mailing Address - Country:US
Mailing Address - Phone:740-533-7087
Mailing Address - Fax:
Practice Address - Street 1:9154 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-7416
Practice Address - Country:US
Practice Address - Phone:304-733-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184876164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse