Individual
TINA S. CHAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP
Contact information
Practice address
PO BOX 748465, ATLANTA, GA 30374-8465
(855) 284-7483
Mailing address
3074 DOGWOOD LN, RICHMOND, IN 47374-3531
(765) 967-0466
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28184688A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71005603A
IN
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
71005603A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28184688A
RN
IN
Enumeration date
07/15/2015
Last updated
06/11/2025
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