Healthcare Provider Details

I. General information

NPI: 1013052497
Provider Name (Legal Business Name): HEATHER COFFEEN CHASTAIN NP - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MICHELLE COFFEEN

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 CORDER RD SUITE 1
WARNER ROBINS GA
31088-3606
US

IV. Provider business mailing address

120-B OSIGIAN BLVD SUITE 100
WARNER ROBINS GA
31088-8939
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-3074
  • Fax: 478-922-3076
Mailing address:
  • Phone: 478-953-5358
  • Fax: 478-953-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number150125
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: