Provider Demographics
NPI:1053063867
Name:CHAMBERS, MACY VICTORIA (APRN)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:VICTORIA
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 SUBLIMITY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GIRDLER
Mailing Address - State:KY
Mailing Address - Zip Code:40943-6412
Mailing Address - Country:US
Mailing Address - Phone:606-545-9892
Mailing Address - Fax:
Practice Address - Street 1:2 TRILLIUM WAY STE 106
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-526-4070
Practice Address - Fax:606-526-4072
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner