Provider Demographics
NPI:1528034337
Name:CHAPPELL, MARILYN KAY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:KAY
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:KAY
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4406 COTTENDALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5852
Mailing Address - Country:US
Mailing Address - Phone:919-596-3169
Mailing Address - Fax:
Practice Address - Street 1:3901 N ROXBORO ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-9888
Practice Address - Fax:919-479-9882
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant