MEDICARE: JAMIE CHASTEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	122344	AR

General Provider Information

NPI Number	:	1154966349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE CHASTEEN

Provider Business Mailing Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:	501-486-4045
Fax Number	:	888-213-5007

Provider Business Practice Location Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:	501-486-4045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	01/07/2020

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Directions to “ JAMIE CHASTEEN ” Practice Location

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