Provider Demographics
NPI:1740706498
Name:CHALKLEY, STEVIE
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:
Last Name:CHALKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21580 FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:JETERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23083-2847
Mailing Address - Country:US
Mailing Address - Phone:804-561-5986
Mailing Address - Fax:
Practice Address - Street 1:21580 FARMERS LN
Practice Address - Street 2:
Practice Address - City:JETERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23083-2847
Practice Address - Country:US
Practice Address - Phone:804-561-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver