Provider Demographics
NPI:1235369380
Name:ANDERSON, CHANTEL KELLY (NP)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:KELLY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:FRANCESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47946-8087
Mailing Address - Country:US
Mailing Address - Phone:219-567-2223
Mailing Address - Fax:219-567-2043
Practice Address - Street 1:112 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FRANCESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47946-8087
Practice Address - Country:US
Practice Address - Phone:219-567-2223
Practice Address - Fax:219-567-2043
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002987A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71002987AOtherNP LICENSE