Provider Demographics
NPI:1083094304
Name:CHAMBERS, STEPHANIE M (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1208 HICKORY BLVD SW STE 102
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-6461
Mailing Address - Country:US
Mailing Address - Phone:828-991-4660
Mailing Address - Fax:828-991-4659
Practice Address - Street 1:1208 HICKORY BLVD SW STE 102
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-6461
Practice Address - Country:US
Practice Address - Phone:828-991-4660
Practice Address - Fax:828-991-4659
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant