Healthcare Provider Details

I. General information

NPI: 1922728807
Provider Name (Legal Business Name): CHAYNNA GATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MULESHOE TRL
ELKLAND MO
65644-7220
US

IV. Provider business mailing address

131 MULESHOE TRL
ELKLAND MO
65644-7220
US

V. Phone/Fax

Practice location:
  • Phone: 417-298-9821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017020458
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: