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NPI Code Detail

MEDICARE: CRYSTAL MARIE CHACKO PA-C

MEDICARE:   CRYSTAL MARIE CHACKO  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA20551TX

General Provider Information

NPI Number : 1063218295
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL MARIE CHACKO PA-C
Provider Business Mailing Address
First Line : 900 DOLAN SPRINGS LN
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-3362
Country : US
Telephone Number : 409-692-9428
Fax Number :
Provider Business Practice Location Address
First Line : 7703 FLOYD CURL DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-3901
Country : US
Telephone Number : 210-567-4240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2025
Last Update Date : 07/01/2026

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Directions to “ CRYSTAL MARIE CHACKO PA-C” Practice Location

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