Provider Demographics
NPI:1487411492
Name:CHANDLER, TIMOTHY RAY (LPN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WALKER AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1896
Mailing Address - Country:US
Mailing Address - Phone:405-370-4031
Mailing Address - Fax:
Practice Address - Street 1:613 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-2005
Practice Address - Country:US
Practice Address - Phone:405-370-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator