Healthcare Provider Details

I. General information

NPI: 1346529252
Provider Name (Legal Business Name): AUDREY PARKER CHEN RN, CPNP-PC/AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVENUE CARILION CLINIC DEPARTMENT OF EMERGENCY MEDICINE
ROANOKE VA
24014
US

IV. Provider business mailing address

1246 FLOYD AVE SW
ROANOKE VA
24015-2529
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6331
  • Fax:
Mailing address:
  • Phone: 502-386-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024169507
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: