Healthcare Provider Details

I. General information

NPI: 1568429868
Provider Name (Legal Business Name): JUDITH DENISE CHESNUTT MN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/23/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST BOX 159
CHATTANOOGA TN
37403-2103
US

IV. Provider business mailing address

163 BRIARSTONE DR
ROSSVILLE GA
30741-3306
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6170
  • Fax:
Mailing address:
  • Phone: 423-432-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPN00000010986
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: