Provider Demographics
NPI:1669982054
Name:CHANCELLOR, ASHLEY COOPER (NP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:COOPER
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3606
Mailing Address - Country:US
Mailing Address - Phone:478-929-8030
Mailing Address - Fax:478-929-8095
Practice Address - Street 1:1707 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3606
Practice Address - Country:US
Practice Address - Phone:478-929-8030
Practice Address - Fax:478-929-0895
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2022-11-30
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2022-11-28
Provider Licenses
StateLicense IDTaxonomies
GA212346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily