Provider Demographics
NPI:1932846037
Name:CHASTEEN, JACOB TYLER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TYLER
Last Name:CHASTEEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JAKE
Other - Middle Name:TYLER
Other - Last Name:CHASTEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1490
Mailing Address - Country:US
Mailing Address - Phone:828-262-3886
Mailing Address - Fax:
Practice Address - Street 1:935 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4948
Practice Address - Country:US
Practice Address - Phone:828-262-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
NC0010-13259363A00000X
FLPA9116112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program