Provider Demographics
NPI:1487056784
Name:SPEIGHT, CHANDRA L (NP)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:L
Last Name:SPEIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:L
Other - Last Name:SPEIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:212 TUCKAHOE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8915
Mailing Address - Country:US
Mailing Address - Phone:252-341-9496
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-215-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily