Provider Demographics
NPI:1285524058
Name:CHASTAIN, STAVROULA PERDIKOGIANNIS (CNP)
Entity type:Individual
Prefix:MS
First Name:STAVROULA
Middle Name:PERDIKOGIANNIS
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 BANKERS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4212
Mailing Address - Country:US
Mailing Address - Phone:859-647-9101
Mailing Address - Fax:
Practice Address - Street 1:8820 BANKERS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4212
Practice Address - Country:US
Practice Address - Phone:859-647-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4042809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily