Provider Demographics
NPI:1649995861
Name:CHAFFIN, ANDREA KAYLAN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAYLAN
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 S RIFE MEDICAL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1457
Mailing Address - Country:US
Mailing Address - Phone:479-338-3030
Mailing Address - Fax:479-338-3079
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE 300
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1457
Practice Address - Country:US
Practice Address - Phone:479-338-3030
Practice Address - Fax:479-338-3079
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty