Provider Demographics
NPI:1295141372
Name:HEARD, CHENNELL
Entity type:Individual
Prefix:
First Name:CHENNELL
Middle Name:
Last Name:HEARD
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 1:9951 ATLANTIC BLVD
Mailing Address - Street 2:#118
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6584
Mailing Address - Country:US
Mailing Address - Phone:904-699-0299
Mailing Address - Fax:904-438-5055
Practice Address - Street 1:9951 ATLANTIC BLVD
Practice Address - Street 2:#118
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6584
Practice Address - Country:US
Practice Address - Phone:904-699-0299
Practice Address - Fax:904-438-5055
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator