Provider Demographics
NPI:1730294042
Name:MCELYEA, CHANDA (NP)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:
Last Name:MCELYEA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PINEBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4365
Mailing Address - Country:US
Mailing Address - Phone:423-579-0101
Mailing Address - Fax:423-579-0101
Practice Address - Street 1:1700 PINEBROOK DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4365
Practice Address - Country:US
Practice Address - Phone:423-579-0101
Practice Address - Fax:423-579-0101
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001187691363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001187691OtherLICENSE NUMBER