Provider Demographics
NPI:1588986905
Name:CHANLER, AMBER C (CPNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:C
Last Name:CHANLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:C
Other - Last Name:SHANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 FACTORY OUTLET DR STE 12
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3057
Mailing Address - Country:US
Mailing Address - Phone:318-372-8797
Mailing Address - Fax:
Practice Address - Street 1:600 FACTORY OUTLET DR STE 12
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3057
Practice Address - Country:US
Practice Address - Phone:318-372-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06662363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2387421Medicaid