MEDICARE: ANDREA KAYLAN CHAFFIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	222093	AR

General Provider Information

NPI Number	:	1649995861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KAYLAN CHAFFIN

Provider Business Mailing Address
First Line	:	2708 S RIFE MEDICAL LN STE 300
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1457
Country	:	US
Telephone Number	:	479-338-3030
Fax Number	:	479-338-3079

Provider Business Practice Location Address
First Line	:	2708 S RIFE MEDICAL LN STE 300
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1457
Country	:	US
Telephone Number	:	479-338-3030
Fax Number	:	479-338-3079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/13/2022

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