Individual
CHANTEL KELLY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2147
(765) 250-9211
Mailing address
1500 SALEM ST, LAFAYETTE, IN 47904-2147
(765) 250-9212
(765) 588-0327
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71002987A
IN
363LF0000X
Family Nurse Practitioner
71002987A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71002987A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71002987A
NP LICENSE
IN
Enumeration date
07/23/2009
Last updated
03/10/2025
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