Provider Demographics
NPI:1881486504
Name:CHESTER, CALLIE (FNP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:CHESTER
Suffix:
Gender:X
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-4318
Mailing Address - Country:US
Mailing Address - Phone:410-991-6172
Mailing Address - Fax:
Practice Address - Street 1:112 BANKS RD STE 1
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-6300
Practice Address - Country:US
Practice Address - Phone:706-677-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN302612163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse