| Doctor Name: | CHESSICA RUNYON |
| NPI Number: | 1174990105 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 20382 |
| Business Practice Address: | 1119 E College St Ste 1 Pulaski, TN - 384784563 |
| Business Phone Number: | 9312078630 |
| Business Fax Number: | 9312078629 |
| Mailing Address: | 1119 E College St, Ste 1 PULASKI |
| State: | TN |
| Postal Code: | 384784563 |
| Phone Number: | 9312078630 |
| Fax Number: | 9312078629 |
| NPI Enumeration Date: | 08/25/2015 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 20382 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |