Provider Demographics
NPI:1619786217
Name:LITTLE AXE, CHASTITY LYNN
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:LYNN
Last Name:LITTLE AXE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 W CRISLER AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-9393
Mailing Address - Country:US
Mailing Address - Phone:918-470-5865
Mailing Address - Fax:
Practice Address - Street 1:1932 W CRISLER AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-9393
Practice Address - Country:US
Practice Address - Phone:918-470-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator