Provider Demographics
NPI:1245780451
Name:JETT, CHASITY
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:JETT
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 1:1242 KNOWLING LOOP
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-3307
Mailing Address - Country:US
Mailing Address - Phone:423-231-6496
Mailing Address - Fax:
Practice Address - Street 1:1242 KNOWLING LOOP
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-3307
Practice Address - Country:US
Practice Address - Phone:423-231-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000177285163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health