Provider Demographics
NPI:1982032926
Name:CHAMBERS, BREAH (APRN)
Entity Type:Individual
Prefix:
First Name:BREAH
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BREAH
Other - Middle Name:
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4132
Mailing Address - Country:US
Mailing Address - Phone:785-856-0708
Mailing Address - Fax:785-856-0709
Practice Address - Street 1:4930 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4132
Practice Address - Country:US
Practice Address - Phone:785-856-0708
Practice Address - Fax:785-856-0709
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038983364SF0001X
KS76147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982032926OtherFAMILY