Provider Demographics
NPI:1134797988
Name:WILEY, CHANTEL N (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:N
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0223
Mailing Address - Country:US
Mailing Address - Phone:225-460-4909
Mailing Address - Fax:225-399-4590
Practice Address - Street 1:10202 PERKINS ROWE STE E-160
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2067
Practice Address - Country:US
Practice Address - Phone:225-460-4909
Practice Address - Fax:225-399-4590
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219070363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA219070OtherAPRN LICENSE