Provider Demographics
NPI:1760128698
Name:CHANDLER, KRISTEN A
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 INDIANA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1036
Mailing Address - Country:US
Mailing Address - Phone:304-254-6773
Mailing Address - Fax:
Practice Address - Street 1:325 4TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1266
Practice Address - Country:US
Practice Address - Phone:304-744-4940
Practice Address - Fax:304-744-4948
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant