Provider Demographics
NPI:1992983829
Name:SISSON, CHASITY MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:MICHELLE
Last Name:SISSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-8870
Mailing Address - Country:US
Mailing Address - Phone:601-687-1391
Mailing Address - Fax:
Practice Address - Street 1:130 N HIGH ST
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360-8870
Practice Address - Country:US
Practice Address - Phone:601-687-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSMS3280738OtherDEA