Provider Demographics
NPI:1023186038
Name:CHAMBERS, LINDA PETERSON (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:PETERSON
Last Name:CHAMBERS
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MS
Mailing Address - Zip Code:39163-0029
Mailing Address - Country:US
Mailing Address - Phone:662-468-2015
Mailing Address - Fax:844-270-1119
Practice Address - Street 1:1493 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:MS
Practice Address - Zip Code:39045-9524
Practice Address - Country:US
Practice Address - Phone:662-468-2015
Practice Address - Fax:662-468-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03581557Medicaid