Provider Demographics
NPI:1518691237
Name:CHASTAIN, ALYSSA CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:CHRISTINE
Other - Last Name:DECKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 E PRIMROSE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4377
Mailing Address - Country:US
Mailing Address - Phone:417-882-1207
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3801 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7268
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022026231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily