Healthcare Provider Details

I. General information

NPI: 1053934026
Provider Name (Legal Business Name): MCKENNA CHANDLER PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 BEVERLY AVE NE STE 40
SALEM OR
97305-1374
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-0076
  • Fax: 503-588-7578
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA213549
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: