Healthcare Provider Details

I. General information

NPI: 1497577357
Provider Name (Legal Business Name): CHANDLER JOELLE CHASTAIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDLER JOELLE JACKSON

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WESTSIDE DR NW
CLEVELAND TN
37312-3605
US

IV. Provider business mailing address

PO BOX 80426
CHATTANOOGA TN
37414-7426
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-1760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37432
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: