Provider Demographics
NPI:1699513820
Name:CHANDLER, KATELYN TAYLOR
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:TAYLOR
Last Name:CHANDLER
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 1:1928 RIFLE RANGE LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1928 RIFLE RANGE LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4424
Practice Address - Country:US
Practice Address - Phone:225-921-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered