Healthcare Provider Details

I. General information

NPI: 1811326184
Provider Name (Legal Business Name): CHASTITY A WARNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ADAMS ST
JEFFERSON CITY MO
65101-3058
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 573-556-6589
  • Fax: 573-556-6294
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006019244
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: