Provider Demographics
NPI:1497577357
Name:CHASTAIN, CHANDLER JOELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:JOELLE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:JOELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 80426
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-7426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2620 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3605
Practice Address - Country:US
Practice Address - Phone:423-339-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily