Provider Demographics
NPI:1902966765
Name:SMITH-STEWARD FASON, CHANTE (FNP, APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHANTE
Middle Name:
Last Name:SMITH-STEWARD FASON
Suffix:
Gender:F
Credentials:FNP, APRN
Other - Prefix:MRS
Other - First Name:CHANTE
Other - Middle Name:
Other - Last Name:FASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, APRN
Mailing Address - Street 1:6005 PARK AVE STE 630B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5226
Mailing Address - Country:US
Mailing Address - Phone:901-767-1136
Mailing Address - Fax:901-767-0436
Practice Address - Street 1:6005 PARK AVE STE 630B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5226
Practice Address - Country:US
Practice Address - Phone:901-767-1136
Practice Address - Fax:901-767-0436
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007696363LP2300X, 363LF0000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519348Medicaid
TN1519348Medicaid