Basic Information
| Provider Information | |||||||||
| NPI: | 1982617221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDLER | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | LITTLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LITTLE | ||||||||
| OtherFirstName: | VICKI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5220 PARK AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016858245 | ||||||||
| FaxNumber: | 9016858248 | ||||||||
| Practice Location | |||||||||
| Address1: | 5220 PARK AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016858245 | ||||||||
| FaxNumber: | 9016858248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RN64657 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | APN5907 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4069433 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |