Provider Demographics
NPI:1659714756
Name:CHAMNESS, COREY BRYANT (DO)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:BRYANT
Last Name:CHAMNESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:BRYANT
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2050 W KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8946
Mailing Address - Country:US
Mailing Address - Phone:918-882-0440
Mailing Address - Fax:918-882-0441
Practice Address - Street 1:2050 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8946
Practice Address - Country:US
Practice Address - Phone:918-882-0440
Practice Address - Fax:918-882-0441
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine