Provider Demographics
NPI:1568000503
Name:CAMPBELL, CHASITY SHAVON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:SHAVON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1424
Mailing Address - Country:US
Mailing Address - Phone:870-838-7530
Mailing Address - Fax:
Practice Address - Street 1:1521 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1424
Practice Address - Country:US
Practice Address - Phone:870-838-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily