Healthcare Provider Details

I. General information

NPI: 1962977215
Provider Name (Legal Business Name): MRS. BREANNA CHAMBLISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ZION RD
HENDERSON KY
42420-4886
US

IV. Provider business mailing address

4076 SHADY HOLLOW DR
HENDERSON KY
42420-9275
US

V. Phone/Fax

Practice location:
  • Phone: 270-831-8570
  • Fax:
Mailing address:
  • Phone: 301-616-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: