Provider Demographics
NPI:1467097956
Name:STENGEL, CHANDLER (PA-C)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:STENGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 DEERFIELD CV
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-1214
Mailing Address - Country:US
Mailing Address - Phone:901-692-4047
Mailing Address - Fax:
Practice Address - Street 1:7900 AIRWAYS BLVD., STE B102
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5809
Practice Address - Country:US
Practice Address - Phone:662-548-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3974363A00000X
MSPA00446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant