Provider Demographics
NPI:1144389545
Name:CHAMBERS, KATHRYN J (AOCNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:AOCNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:J
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:513-451-4033
Mailing Address - Fax:513-451-4118
Practice Address - Street 1:3401 PGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2824
Practice Address - Country:US
Practice Address - Phone:561-366-4100
Practice Address - Fax:561-776-8801
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9404235363L00000X
OHRN-331267163W00000X
TX690502363L00000X
OHNP-09365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110883400Medicaid
OH2763488Medicaid
TX159141401Medicaid
OH2763488Medicaid
8A8169Medicare ID - Type Unspecified