MEDICARE: ALEXIS CHANEY APRN

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	53-80826-051	KS

General Provider Information

NPI Number	:	1902559826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS CHANEY APRN

Provider Business Mailing Address
First Line	:	PO BOX 512
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-0512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 OAK ST STE C
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-1046
Country	:	US
Telephone Number	:	913-348-6280
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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