Jennifer L. Chavis, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R189332 Issued in MD

Practice address

4821 Butler Rd # 3C
Glyndon, MD 21136-5686

Phone

(443) 801-5914

NPI assigned

Aug 2, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689083735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 PINEY GROVE ROAD",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "21136",
            "telephone_number": "443-801-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4821 BUTLER RD # 3C",
            "city": "GLYNDON",
            "state": "MD",
            "postal_code": "211365686",
            "telephone_number": "443-801-5914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4825 Butler Rd",
            "address_2": "Suite 2B",
            "address_purpose": "LOCATION",
            "city": "Glyndon",
            "state": "MD",
            "postal_code": "210712100",
            "country_code": "US",
            "telephone_number": "443-801-5914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVIS",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-02",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R189332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Glyndon, MD
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.