MEDICARE: VICKI LITTLE CHANDLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	RN64657	TN
2	207Q00000X	Family Medicine Physician	APN5907	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4069433	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982617221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LITTLE CHANDLER FNP

Provider Business Mailing Address
First Line	:	5220 PARK AVE STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3541
Country	:	US
Telephone Number	:	901-685-8245
Fax Number	:	901-685-8248

Provider Business Practice Location Address
First Line	:	5220 PARK AVE
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3500
Country	:	US
Telephone Number	:	901-685-8245
Fax Number	:	901-685-8248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/10/2025

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