Provider Demographics
NPI:1740655091
Name:CHANDLER, KAJUANDRA (NP)
Entity type:Individual
Prefix:
First Name:KAJUANDRA
Middle Name:
Last Name:CHANDLER
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:PO BOX 18692
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38181-0692
Mailing Address - Country:US
Mailing Address - Phone:901-405-0911
Mailing Address - Fax:901-328-1361
Practice Address - Street 1:2747 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4580
Practice Address - Country:US
Practice Address - Phone:901-590-3332
Practice Address - Fax:901-328-1361
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901379363LF0000X
TN20927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019941Medicaid