MEDICARE: MRS. DANIELLE MARIE CHASTAIN

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	104100000X	Social Worker		AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700359098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE MARIE CHASTAIN

Provider Business Mailing Address
First Line	:	PO BOX 2109
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-2109
Country	:	US
Telephone Number	:	479-967-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 W MAIN
Second Line	:	SUITE 2
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801
Country	:	US
Telephone Number	:	479-219-1219
Fax Number	:

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

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	12/10/2025

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