Provider Demographics
NPI:1366052821
Name:WILLMOUTH, CHASITY (RN)
Entity type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:
Last Name:WILLMOUTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 MANSON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-3680
Mailing Address - Country:US
Mailing Address - Phone:504-782-9685
Mailing Address - Fax:
Practice Address - Street 1:1609 MANSON AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-3680
Practice Address - Country:US
Practice Address - Phone:504-782-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230675367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered