Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 19573 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R867282 | MS |
NPI | 1003205857 |
---|---|
Provider Name | Ms. Chastity H Heath |
First Address | Batesville, MS 38606-3003 |
Second Address | Memphis, TN 38128-2595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2015 |
Last Update Date | 08/10/2015 |