Provider Demographics
NPI:1710602586
Name:CHESTNUT, JO ANN (PRSS)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1791
Mailing Address - Country:US
Mailing Address - Phone:304-645-1787
Mailing Address - Fax:304-645-3630
Practice Address - Street 1:9109 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1791
Practice Address - Country:US
Practice Address - Phone:304-645-1787
Practice Address - Fax:304-645-3630
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19-925175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist