Provider Demographics
NPI:1447149869
Name:TANNER, CHASTITY (APRN)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 N HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-2889
Mailing Address - Country:US
Mailing Address - Phone:870-329-6468
Mailing Address - Fax:
Practice Address - Street 1:8140 N HAVEN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-2889
Practice Address - Country:US
Practice Address - Phone:870-329-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23393277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily