Provider Demographics
NPI:1366148371
Name:CHAVERS, SHAKELL LANAE (FNP)
Entity type:Individual
Prefix:
First Name:SHAKELL
Middle Name:LANAE
Last Name:CHAVERS
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 1:645 HUTCHINSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-6320
Mailing Address - Country:US
Mailing Address - Phone:229-395-6019
Mailing Address - Fax:
Practice Address - Street 1:1241 W THARPE ST STE C01
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4661
Practice Address - Country:US
Practice Address - Phone:850-778-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily