Healthcare Provider Details

I. General information

NPI: 1740101831
Provider Name (Legal Business Name): PEGGY A CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 KING AVE
MEMPHIS TN
38109-3144
US

IV. Provider business mailing address

736 KING AVE
MEMPHIS TN
38109-3144
US

V. Phone/Fax

Practice location:
  • Phone: 209-337-2426
  • Fax:
Mailing address:
  • Phone: 209-337-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: