Healthcare Provider Details

I. General information

NPI: 1750316501
Provider Name (Legal Business Name): MINDY CHANDLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PORTER PIKE
BOWLING GREEN KY
42103-9581
US

IV. Provider business mailing address

1035 PORTER PIKE
BOWLING GREEN KY
42103-9581
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-1199
  • Fax: 270-782-9996
Mailing address:
  • Phone: 270-843-1199
  • Fax: 270-782-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number148462
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6012P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: