Provider Demographics
NPI:1245846179
Name:CHAVIS, CHASITY NICHOLE (RN)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:NICHOLE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:SC
Mailing Address - Zip Code:29567-0397
Mailing Address - Country:US
Mailing Address - Phone:843-506-4067
Mailing Address - Fax:
Practice Address - Street 1:2159 HWY 9 WEST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536
Practice Address - Country:US
Practice Address - Phone:843-506-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse