Provider Demographics
NPI:1295723286
Name:CHASTAIN, DONNA KAY (APN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4510
Mailing Address - Country:US
Mailing Address - Phone:501-354-4637
Mailing Address - Fax:501-354-2248
Practice Address - Street 1:4 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4510
Practice Address - Country:US
Practice Address - Phone:501-354-4637
Practice Address - Fax:501-354-2248
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01404363LF0000X
ARA01404APN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137630758Medicaid
AR137630758Medicaid
AR5U312Medicare ID - Type Unspecified