Healthcare Provider Details

I. General information

NPI: 1356268007
Provider Name (Legal Business Name): ANGELA CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 TRACE COLONY PARK DR STE B
RIDGELAND MS
39157-8810
US

IV. Provider business mailing address

3117 TYNES DR
BYRAM MS
39272-9482
US

V. Phone/Fax

Practice location:
  • Phone: 813-926-5454
  • Fax:
Mailing address:
  • Phone: 205-370-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-101383
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: