Provider Demographics
NPI:1528328960
Name:CHANEY, JENNIFER CRYSTAL (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CRYSTAL
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:306 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-439-4543
Mailing Address - Fax:606-436-4291
Practice Address - Street 1:306 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-4543
Practice Address - Fax:606-436-4291
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2890207Q00000X
KY47736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine