Provider Demographics
NPI:1851957500
Name:CHASTINE, BRYANT ALLEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:ALLEN
Last Name:CHASTINE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:BRYANT
Other - Middle Name:ALLEN
Other - Last Name:CHASTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:829 HINTON PLACE RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-9610
Mailing Address - Country:US
Mailing Address - Phone:205-310-4755
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered