Healthcare Provider Details

I. General information

NPI: 1568524536
Provider Name (Legal Business Name): MONA S CHARLESWORTH APN, CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 GUNBARREL RD
CHATTANOOGA TN
37421-3151
US

IV. Provider business mailing address

PO BOX 21867
CHATTANOOGA TN
37424-0867
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-0500
  • Fax: 423-899-2411
Mailing address:
  • Phone: 423-899-0500
  • Fax: 423-899-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000041125
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0000005320
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: