Healthcare Provider Details

I. General information

NPI: 1629125083
Provider Name (Legal Business Name): CHANTEL EVE UNSELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WOODLAND DR
ELIZABETHTOWN KY
42701-2749
US

IV. Provider business mailing address

8 OLD BLOOMFIELD PIKE STE 400
BARDSTOWN KY
40004
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-5963
  • Fax: 270-769-9051
Mailing address:
  • Phone: 502-275-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA1006251
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: