Provider Demographics
NPI:1942285465
Name:JEFFREYS, CHANTIL DICUS (NP)
Entity Type:Individual
Prefix:
First Name:CHANTIL
Middle Name:DICUS
Last Name:JEFFREYS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 CENTRE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6308
Mailing Address - Country:US
Mailing Address - Phone:901-684-5500
Mailing Address - Fax:901-684-5515
Practice Address - Street 1:2999 CENTRE OAK WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6308
Practice Address - Country:US
Practice Address - Phone:901-684-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN105541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3907377Medicare ID - Type Unspecified
P70385Medicare UPIN