Healthcare Provider Details

I. General information

NPI: 1205580412
Provider Name (Legal Business Name): JAMES CHANEY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 LAREDO DR
LEXINGTON KY
40517-2121
US

IV. Provider business mailing address

654 S 7TH ST
LOUISVILLE KY
40203-4022
US

V. Phone/Fax

Practice location:
  • Phone: 859-699-9341
  • Fax:
Mailing address:
  • Phone: 202-657-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number3014959
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: