Provider Demographics
NPI:1821366436
Name:CHASTAIN, LATRICIA DAIL (NP-C)
Entity Type:Individual
Prefix:
First Name:LATRICIA
Middle Name:DAIL
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LATRICIA
Other - Middle Name:MAE
Other - Last Name:DAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 DUBLIN SQUARE RD
Mailing Address - Street 2:STE B
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8600
Mailing Address - Country:US
Mailing Address - Phone:336-610-1300
Mailing Address - Fax:336-672-6001
Practice Address - Street 1:44 MCNEILL PLZ
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8602
Practice Address - Country:US
Practice Address - Phone:336-610-1300
Practice Address - Fax:336-672-6001
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005452363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2519Medicaid
NC1821366436Medicaid
SCNP2519Medicaid
NCNC4045AMedicare PIN