Provider Demographics
NPI:1780244970
Name:FREDERICK, CHASTITY RANAE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:RANAE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHASTITY
Other - Middle Name:RANAE
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1948
Mailing Address - Country:US
Mailing Address - Phone:317-745-4451
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL LN STE 300
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-2000
Practice Address - Country:US
Practice Address - Phone:317-456-9064
Practice Address - Fax:317-386-5468
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009115A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily