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1114897634 NPI number — CORIE R CHANEY NP

NPI Number: 1114897634
Health Care Provider/Practitioner: CORIE R CHANEY NP

Information about “1114897634” NPI (CORIE R CHANEY NP) exists in 1114897634 in HTML format HTML  |  1114897634 in plain Text format TXT  |  1114897634 in PDF (Portable Document Format) PDF  |  1114897634 in an XML format XML  formats.

NPI Number : 1114897634 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114897634",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHANEY",
    "FirstName": "CORIE",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1690 N 350 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WASHINGTON",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47501-7665",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "583 S CLARIZZ BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLOOMINGTON",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47401-5515",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-353-2700",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/10/2025",
    "LastUpdateDate": "12/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208VP0014X",
          "TaxonomyName": "Interventional Pain Medicine Physician",
          "LicenseNumber": "71017402A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "71017402A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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