Provider Demographics
NPI:1558503698
Name:CHAMBERS, MARTHA MICHELLE (CFNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MICHELLE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-1186
Mailing Address - Country:US
Mailing Address - Phone:601-526-0790
Mailing Address - Fax:601-526-0795
Practice Address - Street 1:119 SOUTH OAK STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:RAYMOND
Practice Address - State:MS
Practice Address - Zip Code:39154
Practice Address - Country:US
Practice Address - Phone:601-526-0790
Practice Address - Fax:601-526-0795
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily