Healthcare Provider Details

I. General information

NPI: 1609051846
Provider Name (Legal Business Name): BRIAN C CHALKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 DUNLOP LN
CLARKSVILLE TN
37040-5015
US

IV. Provider business mailing address

1817A MADISON ST STE 1
CLARKSVILLE TN
37043-2930
US

V. Phone/Fax

Practice location:
  • Phone: 931-551-1795
  • Fax: 931-551-1798
Mailing address:
  • Phone: 931-551-1795
  • Fax: 931-551-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number13014
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3005572
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: