Healthcare Provider Details

I. General information

NPI: 1568705283
Provider Name (Legal Business Name): CHASITY DANIELLE LONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 03/03/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 KINGSTON PIKE
KNOXVILLE TN
37919-6346
US

IV. Provider business mailing address

1454 OLD HICKORY LN
LENOIR CITY TN
37772-7048
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-5156
  • Fax:
Mailing address:
  • Phone: 606-269-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN17536
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: