Healthcare Provider Details

I. General information

NPI: 1255542270
Provider Name (Legal Business Name): KRISTEL STATON CHASE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 KINGOLD BLVD STE B
SNOW HILL NC
28580-1303
US

IV. Provider business mailing address

585 PAULS PATH RD
LA GRANGE NC
28551-8386
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-8181
  • Fax: 252-747-8946
Mailing address:
  • Phone: 252-566-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number195840
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number195840
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number195840
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: