Healthcare Provider Details

I. General information

NPI: 1518424753
Provider Name (Legal Business Name): CHASTIDY JO RICHARDS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHASTIDY JO HELLER

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-3091
  • Fax: 740-773-3985
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.158565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: