Provider Demographics
NPI:1164223913
Name:DEJONGE, CHANDLER (PA-C)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:DEJONGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5757
Mailing Address - Country:US
Mailing Address - Phone:417-844-8030
Mailing Address - Fax:
Practice Address - Street 1:501 N OLD WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9490
Practice Address - Country:US
Practice Address - Phone:417-269-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant