Basic Information
| Provider Information | |||||||||
| NPI: | 1336689827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUMBLEY | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 AUDUBON PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026368004 | ||||||||
| FaxNumber: | 5026368384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2017 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 3011154 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 226798 | 01 | KY | SIHO-CTS | OTHER | K224300 | 01 | KY | MEDICARE | OTHER | 7100455850 | 05 | KY | MEDICAID | 000001075941 | 01 | KY | ANTHEM-CTS | OTHER | 300001645 | 05 | IN | MEDICAID | 50124976 | 01 | KY | PASSPORT-CTS | OTHER |