| NPI | 1366094880 |
|---|---|
| Former Name | COURTNEY CHASTAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009143A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28209220A) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-18 |