Provider Demographics
NPI:1245074236
Name:HENRIETTA LEE CHAMBERS, LLC
Entity type:Organization
Organization Name:HENRIETTA LEE CHAMBERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:337-354-6301
Mailing Address - Street 1:12006 OLD JEANERETTE RD
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-5928
Mailing Address - Country:US
Mailing Address - Phone:337-354-6301
Mailing Address - Fax:
Practice Address - Street 1:105 MARIE ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2425
Practice Address - Country:US
Practice Address - Phone:337-354-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty