Provider Demographics
NPI:1518424753
Name:RICHARDS, CHASTIDY JO (LPN)
Entity Type:Individual
Prefix:
First Name:CHASTIDY
Middle Name:JO
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHASTIDY
Other - Middle Name:JO
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-592-3091
Practice Address - Fax:740-773-3985
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.158565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse