Individual
CHANCELER PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 745-5253
Mailing address
130 CALO LN, LAKE OZARK, MO 65049-9208
(573) 745-5253
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2023011514
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023011514
LICENSE
MO
Enumeration date
05/13/2026
Last updated
05/13/2026
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