Provider Demographics
NPI:1700451903
Name:CHAMBERS, ALEXIS JAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JAYNE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:J
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-647-4085
Mailing Address - Fax:
Practice Address - Street 1:727 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1660
Practice Address - Country:US
Practice Address - Phone:502-647-4085
Practice Address - Fax:502-647-4098
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016142367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100740190Medicaid
IN300072057Medicaid