Provider Demographics
NPI:1962153544
Name:CHASON, KACI (ARNP)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:CHASON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5581
Mailing Address - Country:US
Mailing Address - Phone:863-225-1244
Mailing Address - Fax:863-591-4744
Practice Address - Street 1:721 E PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5581
Practice Address - Country:US
Practice Address - Phone:863-225-1244
Practice Address - Fax:863-591-4744
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9347074163W00000X
FL11017630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse