Provider Demographics
NPI:1255542270
Name:CHASE, KRISTEL STATON (RN)
Entity type:Individual
Prefix:
First Name:KRISTEL
Middle Name:STATON
Last Name:CHASE
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 1:585 PAULS PATH RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8386
Mailing Address - Country:US
Mailing Address - Phone:252-566-4691
Mailing Address - Fax:
Practice Address - Street 1:227 KINGOLD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195840163W00000X, 163WC1500X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC195840OtherRN LICENSE #