Provider Demographics
NPI:1699291724
Name:CHASTAIN, KATHERINE MARIE (PA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:FATHEREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2358 LIFESTYLE WAY STE 212
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2291
Mailing Address - Country:US
Mailing Address - Phone:423-521-1100
Mailing Address - Fax:421-521-1200
Practice Address - Street 1:2358 LIFESTYLE WAY STE 212
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2291
Practice Address - Country:US
Practice Address - Phone:423-521-1100
Practice Address - Fax:421-521-1200
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant