Provider Demographics
NPI:1265781876
Name:STANTON, CHRISTLE CHENILLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTLE
Middle Name:CHENILLE
Last Name:STANTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 UNION AVE # 204
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3725
Mailing Address - Country:US
Mailing Address - Phone:662-402-4134
Mailing Address - Fax:
Practice Address - Street 1:1700 CRESCENT MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-7417
Practice Address - Country:US
Practice Address - Phone:662-252-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16876363LF0000X
ARA004450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily