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General NPI Number Information
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NPI Number | 1053795435
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Entity Type | Individual
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Provider Name | TINA S. CHAVIS FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | PO BOX 748465
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City | ATLANTA
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State | GA
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Zip | 30374-8465
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Country | US
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Telephone | 855-284-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 3074 DOGWOOD LN
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City | RICHMOND
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State | IN
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Zip | 47374-3531
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Country | US
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Telephone | 765-967-0466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28184688A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 71005603A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71005603A
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License Number State | IN
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