Provider Demographics
NPI:1134447816
Name:CHANEY, JOHN GARY (APMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GARY
Last Name:CHANEY
Suffix:
Gender:M
Credentials:APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19065 N JOOR RD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-8411
Mailing Address - Country:US
Mailing Address - Phone:225-654-3829
Mailing Address - Fax:
Practice Address - Street 1:4040 NORTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3829
Practice Address - Country:US
Practice Address - Phone:225-928-2468
Practice Address - Fax:225-928-2498
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2137409Medicaid