Provider Demographics
NPI:1174084537
Name:TIMMONS, CHAPPEL TENILLE
Entity type:Individual
Prefix:
First Name:CHAPPEL
Middle Name:TENILLE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-3100
Mailing Address - Fax:843-777-3111
Practice Address - Street 1:2437 WILLWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3904
Practice Address - Country:US
Practice Address - Phone:843-777-3100
Practice Address - Fax:843-777-3111
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily