DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: CHANCELER PEMBERTON

MEDICARE: CHANCELER PEMBERTON
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
1164W00000XLicensed Practical Nurse2023011514MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12023011514OTHERMOLICENSE

General Provider Information

NPI Number : 1760310163
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANCELER PEMBERTON
Provider Business Mailing Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 573-745-5253
Fax Number :
Provider Business Practice Location Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 573-745-5253
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2026
Last Update Date : 05/13/2026

Similar Medicare Providers

1285562546 — MARY ANN DUCKWORTH
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 573-746-7361
Practice Fax:
1669510384 — BRENN ROBERT GENT LPC
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 573-365-2221
Practice Fax: 573-365-2224
1285969956 — MRS. KIMBERLY DAWN KUCSIK LCSW
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 573-365-2221
Practice Fax: 573-365-2224
1811222573 — LANDON LEE KIRK MSW, LCSW
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 573-365-2221
Practice Fax: 573-365-2224
1588932602 — MRS. CORY TAYLOR NEUSCHE MA, PLPC
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 866-153-1375
Practice Fax:
1134475635 — CHANGE ACADEMY LAKE OF THE OZARKS
Practice Location Address:
130 CALO LN
LAKE OZARK, MO
65049-9208
Practice Phone: 573-200-1605
Practice Fax:

Directions to “ CHANCELER PEMBERTON ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.