Provider Demographics
NPI:1730067109
Name:PEDIGO, CHANTELLE (FNP)
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHANTELLE
Other - Middle Name:
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 FISHBURN RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-4317
Mailing Address - Country:US
Mailing Address - Phone:615-655-4088
Mailing Address - Fax:
Practice Address - Street 1:330 FISHBURN RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-4317
Practice Address - Country:US
Practice Address - Phone:615-655-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily