Healthcare Provider Details

I. General information

NPI: 1104586171
Provider Name (Legal Business Name): ANDREW DAUGHTON CHAMBERS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

IV. Provider business mailing address

2620 LAKE NORRIS RD
LAKE MS
39092-9511
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-6301
  • Fax: 601-732-2777
Mailing address:
  • Phone: 160-139-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905060
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: