Provider Demographics
NPI:1659714756
Name:CHAMNESS, COREY BRYANT (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:BRYANT
Last Name:CHAMNESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:BRYANT
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8115 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4331
Mailing Address - Country:US
Mailing Address - Phone:918-254-6315
Mailing Address - Fax:918-403-6315
Practice Address - Street 1:8115 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4331
Practice Address - Country:US
Practice Address - Phone:918-254-6315
Practice Address - Fax:918-403-6315
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine