Provider Demographics
NPI:1558492306
Name:CHANEY, JENIPHER E (ANP)
Entity Type:Individual
Prefix:
First Name:JENIPHER
Middle Name:E
Last Name:CHANEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 OLD HWY 51
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011
Mailing Address - Country:US
Mailing Address - Phone:901-837-7979
Mailing Address - Fax:901-837-7999
Practice Address - Street 1:1880 OLD HWY 51 SUITE C
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011
Practice Address - Country:US
Practice Address - Phone:901-837-7979
Practice Address - Fax:901-837-7999
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMC1549255Medicare UPIN