Provider Demographics
NPI:1437797602
Name:CHESTANG, AIMMEE ROCHELLE (NP)
Entity Type:Individual
Prefix:
First Name:AIMMEE
Middle Name:ROCHELLE
Last Name:CHESTANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHASTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-7004
Mailing Address - Country:US
Mailing Address - Phone:601-807-0921
Mailing Address - Fax:
Practice Address - Street 1:33 CHASTAIN LN
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-7004
Practice Address - Country:US
Practice Address - Phone:601-807-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903721363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner