Healthcare Provider Details

I. General information

NPI: 1043704455
Provider Name (Legal Business Name): CHASTITY D AYERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

IV. Provider business mailing address

3479 COUNTY ROAD 94
FLORENCE AL
35634-4845
US

V. Phone/Fax

Practice location:
  • Phone: 256-288-3333
  • Fax: 256-288-3334
Mailing address:
  • Phone: 256-740-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-121665
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: