Healthcare Provider Details

I. General information

NPI: 1376800250
Provider Name (Legal Business Name): CHANIN HILAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 W FAIRVIEW AVE
EDDYVILLE KY
42038-7386
US

IV. Provider business mailing address

627 W FAIRVIEW AVE
EDDYVILLE KY
42038-7386
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-5454
  • Fax: 270-388-5452
Mailing address:
  • Phone: 270-388-5454
  • Fax: 270-388-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3003618
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: