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General NPI Number Information
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NPI Number | 1902966765
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Entity Type | Individual
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Provider Name | CHANTE SMITH-FASON FNP, APRN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 6005 PARK AVE STE 630B
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City | MEMPHIS
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State | TN
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Zip | 38119-5226
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Country | US
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Telephone | 901-767-1136
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Fax | 901-767-0436
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Provider Business Mailing Address
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Address Line | 5821 PARK AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-5134
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Country | US
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Telephone | 901-450-3995
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Fax | 901-450-3993
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN0000007696
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7696
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000007696
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License Number State | TN
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