Healthcare Provider Details

I. General information

NPI: 1114897634
Provider Name (Legal Business Name): CORIE R CHANEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 S CLARIZZ BLVD
BLOOMINGTON IN
47401-5515
US

IV. Provider business mailing address

1690 N 350 E
WASHINGTON IN
47501-7665
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number71017402A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017402A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: