Healthcare Provider Details

I. General information

NPI: 1902966765
Provider Name (Legal Business Name): CHANTE SMITH-FASON FNP, APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTE SMITH-FASON FNP, APRN, PMHNP

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 630B
MEMPHIS TN
38119-5226
US

IV. Provider business mailing address

5821 PARK AVE
MEMPHIS TN
38119-5134
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-1136
  • Fax: 901-767-0436
Mailing address:
  • Phone: 901-450-3995
  • Fax: 901-450-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000007696
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7696
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007696
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: