Healthcare Provider Details

I. General information

NPI: 1891611752
Provider Name (Legal Business Name): CHASTITY MICHELLE HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 HIGHWAY 45 BYP APT A201
JACKSON TN
38305-0627
US

IV. Provider business mailing address

3162 HIGHWAY 45 BYP APT A201
JACKSON TN
38305-0627
US

V. Phone/Fax

Practice location:
  • Phone: 731-223-4573
  • Fax:
Mailing address:
  • Phone: 731-223-4573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-463705
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: