Organization
CHENNELL FAMILY WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA CHENNELL MD (OWNER)
(620) 480-9597
Entity
Organization
Contact information
Practice address
1101 N MAIN ST, MCPHERSON, KS 67460-2845
(620) 504-5996
(888) 263-5552
Mailing address
1101 N MAIN ST, MCPHERSON, KS 67460-2845
(620) 504-5996
(888) 263-5552
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-36397
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-36397
STATE LICENSE
KS
05
—
201207900A
—
KS
Enumeration date
07/31/2018
Last updated
10/14/2020
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