Provider Demographics
NPI:1558192443
Name:CHASTEEN, MCKENZIE GRACE (WHNP/CNM)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:GRACE
Last Name:CHASTEEN
Suffix:
Gender:F
Credentials:WHNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HODGES AND MILLER RD
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9024
Mailing Address - Country:US
Mailing Address - Phone:828-406-4324
Mailing Address - Fax:
Practice Address - Street 1:4001 FAIR RIDGE DR STE 304
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-273-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024191965367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife