Provider Demographics
NPI:1447980073
Name:CHISNALL, HAIDEN RENEE (DNP, APRN, CPNP)
Entity type:Individual
Prefix:DR
First Name:HAIDEN
Middle Name:RENEE
Last Name:CHISNALL
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP
Other - Prefix:
Other - First Name:HAIDEN
Other - Middle Name:RENEE
Other - Last Name:JETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3410 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-1876
Mailing Address - Country:US
Mailing Address - Phone:870-333-5466
Mailing Address - Fax:
Practice Address - Street 1:3410 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-1876
Practice Address - Country:US
Practice Address - Phone:870-333-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120992363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics