Provider Demographics
NPI:1588221071
Name:CHANDLER, KYLE ALLEN
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALLEN
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GOVERNMENT ST BLDG E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-4802
Mailing Address - Country:US
Mailing Address - Phone:225-364-2550
Mailing Address - Fax:225-364-2235
Practice Address - Street 1:1120 GOVERNMENT ST BLDG E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-4802
Practice Address - Country:US
Practice Address - Phone:225-364-2550
Practice Address - Fax:225-364-2235
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator