Provider Demographics
NPI:1184968828
Name:CANTWELL, CHASTIN (PA-C)
Entity type:Individual
Prefix:
First Name:CHASTIN
Middle Name:
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 TRIMBLE RD.
Mailing Address - Street 2:STE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7126
Mailing Address - Country:US
Mailing Address - Phone:573-397-7434
Mailing Address - Fax:573-397-7431
Practice Address - Street 1:2910 TRIMBLE RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7126
Practice Address - Country:US
Practice Address - Phone:573-397-7434
Practice Address - Fax:573-397-7431
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
MO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant