Provider Demographics
NPI:1669946869
Name:CHAFFEE FAMILY CARE LLC
Entity type:Organization
Organization Name:CHAFFEE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:573-475-7071
Mailing Address - Street 1:206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1002
Mailing Address - Country:US
Mailing Address - Phone:573-475-7071
Mailing Address - Fax:573-475-7237
Practice Address - Street 1:206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1002
Practice Address - Country:US
Practice Address - Phone:573-475-7071
Practice Address - Fax:573-475-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN102448503Medicaid