Individual
MR. MICHAEL JASON CHASTANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP-BC
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 590-5611
(903) 535-6884
Mailing address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 590-5611
(903) 535-6884
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
713739
TX
363LF0000X
Family Nurse Practitioner
713739
TX
363LP2300X
Primary Care Nurse Practitioner
713739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083944185
BCBSTX
TX
05
—
3470247-01
—
TX
01
—
836N74
BCBSTX
TX
01
—
P01436330
RR MEDICARE
TX
Enumeration date
01/12/2010
Last updated
09/12/2022
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