Healthcare Provider Details

I. General information

NPI: 1447494356
Provider Name (Legal Business Name): DAVID CHAPPELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 FOREST DR
COLUMBIA SC
29204-2363
US

IV. Provider business mailing address

121 BAYERL DR
COLUMBIA SC
29206-3167
US

V. Phone/Fax

Practice location:
  • Phone: 803-603-6622
  • Fax:
Mailing address:
  • Phone: 803-603-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3885
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7507
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3885
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: