Provider Demographics
NPI:1750316501
Name:CHANDLER, MINDY (APRN)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PORTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9581
Mailing Address - Country:US
Mailing Address - Phone:270-843-1199
Mailing Address - Fax:270-782-9996
Practice Address - Street 1:1035 PORTER PIKE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9581
Practice Address - Country:US
Practice Address - Phone:270-843-1199
Practice Address - Fax:270-782-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN148462163WP0808X
KY6012P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074980Medicaid
KY7100074980Medicaid