Provider Demographics
NPI:1447960422
Name:CHASTUN, JENNIFER KAY (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:CHASTUN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W DAVIS ST STE H
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1841
Mailing Address - Country:US
Mailing Address - Phone:936-231-8610
Mailing Address - Fax:
Practice Address - Street 1:3401 W DAVIS ST STE H
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1841
Practice Address - Country:US
Practice Address - Phone:936-231-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1099854OtherBON