MEDICARE: CHANTEL N WILEY FNP, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	219070	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	219070	LA
3	363LF0000X	Family Nurse Practitioner	C-APN.0105022-C-NP	CO
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	C-APN.0105022-C-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	219070	OTHER	LA	APRN LICENSE

General Provider Information

NPI Number	:	1134797988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL N WILEY FNP, PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 223
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-0223
Country	:	US
Telephone Number	:	225-460-4909
Fax Number	:	225-399-4590

Provider Business Practice Location Address
First Line	:	10202 PERKINS ROWE STE E-160
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2067
Country	:	US
Telephone Number	:	225-460-4909
Fax Number	:	225-399-4590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	02/02/2026

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