Healthcare Provider Details

I. General information

NPI: 1609521418
Provider Name (Legal Business Name): CHANDLER SCOTT DENSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GORDON SMITH DR
MOBILE AL
36617-2319
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-4423
  • Fax:
Mailing address:
  • Phone: 251-450-5916
  • Fax: 251-302-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-162687
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: