Healthcare Provider Details

I. General information

NPI: 1972001824
Provider Name (Legal Business Name): CHANTELLE HEATHER HUFFMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTELLE HEATHER DRAKE

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-983-8229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175828
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175828
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001222470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: