Individual
CHANTELLE NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
830 ELM ST, MINNEAPOLIS, KS 67467
(785) 392-2144
(785) 392-3231
Mailing address
830 ELM ST, MINNEAPOLIS, KS 67467
(785) 392-2144
(785) 392-3231
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01944
KS
363AM0700X
Medical Physician Assistant
Primary
15-01944
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201143430B
—
KS
Enumeration date
10/04/2016
Last updated
03/24/2020
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