Provider Demographics
NPI:1588046296
Name:MUMBLOW, KATIE CHANDLER (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:CHANDLER
Last Name:MUMBLOW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-2467
Mailing Address - Country:US
Mailing Address - Phone:864-459-2121
Mailing Address - Fax:
Practice Address - Street 1:601 BROOKS ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-2467
Practice Address - Country:US
Practice Address - Phone:864-459-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily