Healthcare Provider Details

I. General information

NPI: 1659861250
Provider Name (Legal Business Name): EBONEE CHAMBERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 LINDALE AVE STE A
BATON ROUGE LA
70815-4161
US

IV. Provider business mailing address

9420 LINDALE AVE STE A
BATON ROUGE LA
70815-4161
US

V. Phone/Fax

Practice location:
  • Phone: 225-442-3540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number245006
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: